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Ayayo SA, Kontopantelis E, Martin GP, Zghebi SS, Taxiarchi VP, Mamas MA. Temporal trends of in-hospital mortality and its determinants following percutaneous coronary intervention in patients with acute coronary syndrome in England and Wales: A population-based study between 2006 and 2021. Int J Cardiol 2024; 412:132334. [PMID: 38964546 DOI: 10.1016/j.ijcard.2024.132334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/18/2024] [Accepted: 07/01/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND There is limited data around drivers of changes in mortality over time. We aimed to examine the temporal changes in mortality and understand its determinants over time. METHODS 743,149 PCI procedures for patients from the British Cardiovascular Intervention Society (BCIS) database who were aged between 18 and 100 years and underwent Percutaneous Coronary Intervention (PCI) for Acute Coronary Syndrome (ACS) in England and Wales between 2006 and 2021 were included. We decomposed the contributing factors to the difference in the observed mortality proportions between 2006 and 2021 using Fairlie decomposition method. Multiple imputation was used to address missing data. RESULTS Overall, there was an increase in the mortality proportion over time, from 1.7% (95% CI: 1.5% to 1.9%) in 2006 to 3.1% (95% CI: 3.0% to 3.2%) in 2021. 61.2% of this difference was explained by the variables included in the model. ACS subtypes (percentage contribution: 14.67%; 95% CI: 5.76% to 23.59%) and medical history (percentage contribution: 13.50%; 95% CI: 4.33% to 22.67%) were the strongest contributors to the difference in the observed mortality proportions between 2006 and 2021. Also, there were different drivers to mortality changes between different time periods. Specifically, ACS subtypes and severity of presentation were amongst the strongest contributors between 2006 and 2012 while access site and demographics were the strongest contributors between 2012 and 2021. CONCLUSIONS Patient factors and the move towards ST-elevated myocardial infarction (STEMI) PCI have driven the short-term mortality changes following PCI for ACS the most.
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Affiliation(s)
- Sharon A Ayayo
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK.
| | | | - Glen P Martin
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK.
| | - Salwa S Zghebi
- Division of Population Health, Health Services Research and Primary care, The University of Manchester, UK.
| | - Vicky P Taxiarchi
- Centre for Women's Mental Health, Division of Psychology and Mental Health, The University of Manchester, UK.
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke on Trent, UK; National Institute for Health and Care Research (NIHR), Birmingham Biomedical Research Centre, UK.
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2
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Tokuda K, Tanaka A, Uemura Y, Shibata N, Iwama M, Sakaguchi T, Yoshida R, Negishi Y, Tashiro H, Tanaka M, Tatami Y, Yamaguchi S, Yoshioka N, Umemoto N, Ohashi T, Takada Y, Asano H, Yoshida Y, Tanaka T, Noda T, Morishima I, Ishii H, Murohara T. Long-term clinical outcomes following percutaneous coronary intervention in patients aged 90 years and older. J Cardiol 2024:S0914-5087(24)00132-1. [PMID: 39034030 DOI: 10.1016/j.jjcc.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/18/2024] [Accepted: 07/08/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND In an aging society, percutaneous coronary intervention (PCI) for super-elderly patients is commonly performed in clinical practice. However, data are scarce regarding the clinical features and outcomes of this population. METHODS This multicenter observational study enrolled patients aged over 90 years who underwent PCI across 10 hospitals between 2011 and 2020. The study included patients presenting with acute coronary syndrome (ACS) and chronic coronary syndrome (CCS). The occurrence of all-cause and cardiac deaths during hospitalization and after discharge was investigated. RESULTS In total, 402 patients (91.9 ± 2.0 years, 48.3 % male) participated in the study, of whom 77.9 % presented with ACS. The rate of in-hospital death was significantly higher in patients with ACS compared to patients with CCS (15.3 % vs. 2.2 %, p < 0.001). The estimated cumulative incidence rates of all-cause death were 24.3 %, 39.5 %, and 60.4 % at 1, 3, and 5 years, respectively. No significant difference was observed in the occurrence of all-cause death between patients with ACS and CCS. Regarding causes of death after discharge, non-cardiac deaths accounted for just over half of the cases. CONCLUSION This study highlights the clinical features and long-term clinical course of patients aged over 90 years who underwent PCI in a real-world setting. Patients presenting with ACS exhibited a higher rate of in-hospital mortality compared to those with CCS. Following discharge, both ACS and CCS patients experienced comparable and substantial increases in the incidence rates of both cardiac and non-cardiac mortality over time, and a more holistic management approach is warranted.
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Affiliation(s)
- Kotaro Tokuda
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Yusuke Uemura
- Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan
| | - Naoki Shibata
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Makoto Iwama
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | | | - Ruka Yoshida
- Department of Cardiology, Japanese Red Cross Society Nagoya Daini Hospital, Nagoya, Japan
| | - Yosuke Negishi
- Department of Cardiology, Okazaki Municipal Hospital, Okazaki, Japan
| | - Hiroshi Tashiro
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Miho Tanaka
- Department of Cardiology, Konan Kosei Hospital, Konan, Japan
| | - Yosuke Tatami
- Department of Cardiology, Toyota Kosei Hospital, Toyota, Japan
| | | | - Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Norio Umemoto
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Taiki Ohashi
- Department of Cardiology, Toyota Kosei Hospital, Toyota, Japan
| | - Yasunobu Takada
- Department of Cardiology, Konan Kosei Hospital, Konan, Japan
| | - Hiroshi Asano
- Department of Cardiology, Tosei General Hospital, Seto, Japan
| | - Yukihiko Yoshida
- Department of Cardiology, Japanese Red Cross Society Nagoya Daini Hospital, Nagoya, Japan
| | - Toshikazu Tanaka
- Department of Cardiology, Okazaki Municipal Hospital, Okazaki, Japan
| | - Toshiyuki Noda
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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3
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Fujii T, Ikari Y. Incidence of Arterial Thrombotic and Bleeding Events in Patients Who Develop Cancer after ST-elevation Myocardial Infarction. Intern Med 2024; 63:1191-1196. [PMID: 37612081 PMCID: PMC11116013 DOI: 10.2169/internalmedicine.2385-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/13/2023] [Indexed: 08/25/2023] Open
Abstract
Objective Cancers increase the risk of both arterial thrombosis and bleeding. The present study investigated whether or not comorbid new-onset cancers increase arterial thrombosis and bleeding events in patients after ST-elevation myocardial infarction (STEMI). Methods Among 918 consecutive STEMI patients, excluding 300 who used mechanical hemodynamic supportive devices, the 67 with cancer and 851 without cancer were compared with respect to the frequency of thrombotic events, consisting of myocardial infarction (MI) and ischemic stroke, and bleeding events during the trackable observation period in this observational study. The predictive accuracy for bleeding events evaluated by the Academic Research Consortium (ARC) high bleeding risk (HBR) criteria and the patients receiving stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score was assessed by C-statistics. Bleeding events were defined as type 3 or 5 according to the Bleeding Academic Research Consortium criteria. Results During the 1,233.3±1,284.4-day observation period, thrombotic events were observed in 13.4% of patients with cancer and 7.1% of patients without cancer (p=0.06; incidence rates, 2.4 vs. 2.4/100 person-years). MI and ischemic stroke were observed in 6.0% of patients with cancer and 3.5% of patients without cancer (p=0.23; incidence rates, 1.0 vs. 1.2/100 person-years) and 7.5% of patients with cancer and 3.6% of patients without cancer (p=0.18; incidence rates, 1.0 vs. 1.2/100 person-years), respectively. Bleeding events were observed in 26.9% of patients with cancer and 7.6% of patients without cancer (p<0.01; incidence rates, 4.4 vs. 2.4/100 person-years). The C-statistics for predicting bleeding events in patients with and without cancer were 0.65 vs. 0.71 using the ARC-HBR criteria and 0.67 vs. 0.71 using the PRECISE-DAPT scores, respectively. Conclusion Cancers increase unpredictable bleeding but not arterial thrombotic events in patients after STEMI.
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Affiliation(s)
- Toshiharu Fujii
- Division of Cardiology, Tokai University School of Medicine, Japan
| | - Yuji Ikari
- Division of Cardiology, Tokai University School of Medicine, Japan
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4
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Gomes WJ, Marin-Cuartas M, Bakaeen F, Sádaba JR, Dayan V, Almeida R, Parolari A, Myers PO, Borger MA. The ISCHEMIA trial revisited: setting the record straight on the benefits of coronary bypass surgery and the misinterpretation of a landmark trial. Eur J Cardiothorac Surg 2023; 64:ezad361. [PMID: 37889258 DOI: 10.1093/ejcts/ezad361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/12/2023] [Accepted: 10/26/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVES The ISCHEMIA trial is a landmark study that has been the subject of heated debate within the cardiovascular community. In this analysis of the ISCHEMIA trial, we aim to set the record straight on the benefits of coronary artery bypass grafting (CABG) and the misinterpretation of this landmark trial. We sought to clarify and reorient this misinterpretation. METHODS We herein analyse the ISCHEMIA trial in detail and describe how its misinterpretation has led to an erroneous guideline recommendation downgrading for prognosis-altering surgical therapy in these at-risk patients. RESULTS The interim ISCHEMIA trial findings align with previous evidence where CABG reduces the long-term risks of myocardial infarction and mortality in advanced coronary artery disease. The trial outcomes of a significantly lower rate of cardiovascular mortality and a higher rate of non-cardiovascular mortality with the invasive strategy are explained according to landmark evidence. CONCLUSIONS The ISCHEMIA trial findings are aligned with previous evidence and should not be used to downgrade recommendations in recent guidelines for the indisputable benefits of CABG.
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Affiliation(s)
- Walter J Gomes
- Cardiovascular Surgery Discipline, Escola Paulista de Medicina and São Paulo Hospital, Federal University of São Paulo, São Paulo, Brazil
| | - Mateo Marin-Cuartas
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Faisal Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - J Rafael Sádaba
- Department of Cardiac Surgery, University Hospital of Navarra, Pamplona, Spain
| | - Victor Dayan
- Centro Cardiovascular Universitario, Montevideo, Uruguay
| | - Rui Almeida
- University Center Assis Gurgacz Foundation, Cascavel, Paraná, Brazil
| | - Alessandro Parolari
- Unit of Cardiac Surgery, IRCCS Policlinico S. Donato, University of Milan, S. Donato Milanese, Italy
| | - Patrick O Myers
- Division of Cardiac Surgery, CHUV-Lausanne University Hospital, Lausanne, Switzerland
| | - Michael A Borger
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
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5
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Watanabe Y, Yoshikawa T, Isogai T, Sakata K, Yamaguchi T, Arao K, Takaoka Y, Inohara T, Imori Y, Mochizuki H, Yamamoto T, Asai K, Nagao K, Takayama M. Impact of hypoalbuminemia on in-hospital mortality in patients with takotsubo syndrome: A multicenter registry of the Tokyo Cardiovascular Care Unit Network. J Cardiol 2023; 82:356-362. [PMID: 37343932 DOI: 10.1016/j.jjcc.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/23/2023] [Accepted: 05/27/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Hypoalbuminemia is common in critically ill patients and is associated with poor outcomes. However, the relationship between serum albumin levels and clinical outcomes in patients with takotsubo syndrome remains unclear. We examined the impact of hypoalbuminemia on in-hospital mortality in patients with takotsubo syndrome. METHODS Using the multicenter registry of the Tokyo Cardiovascular Care Unit Network between January 2017 and December 2020, we identified 631 eligible patients with takotsubo syndrome (median age, 78 years; male proportion, 22 %) and documented serum albumin levels at admission, which were used to allocate patients to hypoalbuminemia (serum albumin <3.5 g/dL) or normal albumin (serum albumin ≥3.5 g/dL) groups. Patient characteristics and in-hospital mortality were compared between the groups. RESULTS Hypoalbuminemia was detected in 200 (32 %) patients at admission. The hypoalbuminemia group was older and had a higher proportion of men and preceding physical triggers than the normal albumin group. In-hospital all-cause mortality was greater in the hypoalbuminemia group than in the normal albumin group (9.5 % vs. 1.9 %, p < 0.001). Both cardiac (3.0 % vs. 0.5 %, p = 0.015) and non-cardiac (6.5 % vs. 1.4 %, p = 0.002) mortality was greater in the hypoalbuminemia group. In multivariable logistic regression analysis, hypoalbuminemia was independently associated with increased in-hospital mortality, even after adjusting for confounders, including age, sex, and triggering events (odds ratio, 3.23; 95 % confidence interval, 1.31-7.95; p = 0.011). CONCLUSIONS In patients with takotsubo syndrome, hypoalbuminemia is a common comorbidity and is associated with a substantial risk of in-hospital death. Close monitoring and comprehensive critical care are required in these patients.
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Affiliation(s)
- Yukihiro Watanabe
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan; Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.
| | - Tsutomu Yoshikawa
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Toshiaki Isogai
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Konomi Sakata
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Tetsuo Yamaguchi
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Kenshiro Arao
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Yoshimitsu Takaoka
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Taku Inohara
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Yoichi Imori
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan; Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroki Mochizuki
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Takeshi Yamamoto
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan; Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Ken Nagao
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
| | - Morimasa Takayama
- Tokyo Cardiovascular Care Unit Network Scientific Committee, Tokyo, Japan
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6
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Liu J, Chen S, Zhou Y, Huang H, Li Q, Liang Y, Dong S, Huang X, Chen L, Zheng X, Meng R, Jia C, Chen J, Tan N, Liu Y. Proportion and number of incident cancer deaths in coronary artery disease. Cancer Med 2023; 12:20140-20149. [PMID: 37754571 PMCID: PMC10587929 DOI: 10.1002/cam4.6595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/17/2023] [Accepted: 09/15/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Globally, coronary artery disease (CAD) and cancer are the leading causes of death. Studies focusing on the proportion and spectrum of cancer mortality among CAD patients are lacking. We aim to characterize the proportion and spectrum of cancer-specific mortality among patients with CAD. METHODS We analyzed 93,797 hospitalized survivors with angiographically documented CAD between 2007 and 2020 (mean age: 62.8 ± 11.1 years, 24.7% female) from Cardiorenal ImprovemeNt II (CIN-II) cohort. RESULTS During the median follow-up of 4.8 years (IQR: 2.6-7.5), 13,162 (14.0%) patients died after discharge. A total of 1223/7703 (15.8% of cause-specific death) CAD patients died of cancer. The three most common types of cancer-specific death were lung (36.1%), liver (13.3%), and colorectum cancer (12.8%). Furthermore, male (adjusted HR 2.38, 95% CI: 1.99-2.85) and older (≥60 vs. <60 years, adjusted HR 3.25, 95%CI 2.72-3.88) patients had a significantly increased cancer-specific mortality. CONCLUSIONS Our data suggest that nearly one-sixth of death is accounted for cancer among CAD patients within a median follow-up of 4.8 years. Lung, liver, and colorectum cancer are top three cancer-specific mortality. Further studies are needed to reduce cancer mortality for CAD patients, especially in older and male ones. TRAIL REGISTRATION (ClinicalTrials.gov NCT05050877).
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Affiliation(s)
- Jin Liu
- Department of CardiologyGuangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Southern Medical UniversityGuangzhouChina
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease PreventionGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhouChina
| | - Shiqun Chen
- Department of CardiologyGuangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Southern Medical UniversityGuangzhouChina
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease PreventionGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhouChina
- Global Health Research Center, Guangdong Provincial People's HospitalGuangdong Academy of Medical ScienceGuangzhouChina
| | - Yang Zhou
- Department of CardiologyGuangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Southern Medical UniversityGuangzhouChina
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease PreventionGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhouChina
| | - Haozhang Huang
- Department of CardiologyGuangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Southern Medical UniversityGuangzhouChina
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease PreventionGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhouChina
- The Second School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
| | - Qiang Li
- Department of CardiologyGuangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Southern Medical UniversityGuangzhouChina
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease PreventionGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhouChina
| | - Yan Liang
- Department of CardiologyMaoming People's HospitalMaomingChina
| | - Shaohong Dong
- Department of CardiologyShenzhen People's HospitalShenzhenChina
| | - Xiaoyu Huang
- Department of CardiologyYangjiang People's HospitalYangjiangGuangdongP.R. China
| | - Liling Chen
- Department of CardiologyLongyan First Affiliated Hospital of Fujian Medical UniversityLongyanFujianP.R. China
| | - Xueyan Zheng
- Institute of Control and Prevention for Chronic Non‐Infective Disease, Guangdong Provincial Center for Disease Control and PreventionGuangzhouChina
| | - Ruilin Meng
- Institute of Control and Prevention for Chronic Non‐Infective Disease, Guangdong Provincial Center for Disease Control and PreventionGuangzhouChina
| | - Congzhuo Jia
- Department of CardiologyGuangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Southern Medical UniversityGuangzhouChina
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease PreventionGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhouChina
| | - Jiyan Chen
- Department of CardiologyGuangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Southern Medical UniversityGuangzhouChina
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease PreventionGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhouChina
- The Second School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
- Guangdong Provincial People's Hospital, School of MedicineSouth China University of TechnologyGuangzhouChina
| | - Ning Tan
- Department of CardiologyGuangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Southern Medical UniversityGuangzhouChina
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease PreventionGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhouChina
- The Second School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
- Guangdong Provincial People's Hospital, School of MedicineSouth China University of TechnologyGuangzhouChina
| | - Yong Liu
- Department of CardiologyGuangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Southern Medical UniversityGuangzhouChina
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease PreventionGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhouChina
- The Second School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
- Guangdong Provincial People's Hospital, School of MedicineSouth China University of TechnologyGuangzhouChina
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Sakata T, De La Pena C, Ohira S. Functional or Anatomical Completeness of Revascularization After Coronary Artery Bypass Grafting. Ann Thorac Surg 2023; 116:862. [PMID: 37054929 DOI: 10.1016/j.athoracsur.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/02/2023] [Indexed: 04/15/2023]
Affiliation(s)
- Tomoki Sakata
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Corazon De La Pena
- Division of Cardiothoracic Surgery, Westchester Medical Center, 100 Woods Rd, Macy Pavilion, Valhalla, NY 10595
| | - Suguru Ohira
- Division of Cardiothoracic Surgery, Westchester Medical Center, 100 Woods Rd, Macy Pavilion, Valhalla, NY 10595.
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Yildiz BS, Gunduz R, Ozgur S, Cizgici AY, Ozdemir IH. Clinical Outcomes of Comparison Between Type III Coronary Artery Perforation (CAP) and non-CAP Acute Coronary Syndrome Patients During 3-Year Follow-up. Angiology 2023:33197231200029. [PMID: 37694576 DOI: 10.1177/00033197231200029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Coronary artery perforation (CAP) is a potentially fatal complication of percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS). This study aimed to investigate in-hospital, 1-year, and 3-year clinical outcomes of type III CAP during PCI in patients with ACS. The study retrospectively evaluated 118 patients with CAP and 43,226 case-control patients. Clinical, angiographic, and procedural characteristics, management, and outcomes were analyzed retrospectively at 1-year and 3-year follow-ups. The mean age of the patients was 66.5 ± 11.9 years (61.8% males). There was no significant difference in hospital mortality between the type III CAP and non-CAP groups. The all-cause mortality was 33.3% in the CAP group vs 1.8% in the non-CAP group at 1 year, and 28.3% in CAP group vs 6.9% in non-CAP group at 3 years (p = .001 for both comparisons). The procedural, clinical, and 1 and 3-year outcomes of type III CAP showed a relatively high risk of myocardial infarction, coronary artery bypass graft, cerebrovascular event, stent thrombosis, and major bleeding at the 1 and 3-year follow-ups. In addition, non-CAP ACS patients had better survival (log-rank: p < .001, 34.29 months 95% Confidence Interval [33.58-35.00]) than type III CAP ACS patients (29.53 months 95% Confidence Interval [27.28-31.78]) at the 3-year follow-up visit.
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Affiliation(s)
- Bekir S Yildiz
- Department of Cardiology, Celal Bayar University, Manisa, Turkey
| | - Ramazan Gunduz
- Department of Cardiology, Manisa City Hospital, Manisa, Turkey
| | - Su Ozgur
- Department of Biostatistics and Medical Informatics, Ege University, Izmir, Turkey
| | - Ahmet Y Cizgici
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training Research Hospital, Istanbul, Turkey
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9
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Christensen DM, Strange JE, El-Chouli M, Falkentoft AC, Malmborg M, Nouhravesh N, Gislason G, Schou M, Torp-Pedersen C, Sehested TSG. Temporal Trends in Noncardiovascular Morbidity and Mortality Following Acute Myocardial Infarction. J Am Coll Cardiol 2023; 82:971-981. [PMID: 37648355 DOI: 10.1016/j.jacc.2023.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/12/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Due to improved management, diagnosis, and care of myocardial infarction (MI), patients may now survive long enough to increasingly develop serious noncardiovascular conditions. OBJECTIVES This study aimed to test this hypothesis by investigating the temporal trends in noncardiovascular morbidity and mortality following MI. METHODS We conducted a registry-based nationwide cohort study of all Danish patients with MI during 2000 to 2017. Outcomes were cardiovascular and noncardiovascular mortality, incident cancer, incident renal disease, and severe infectious disease. RESULTS From 2000 to 2017, 136,293 consecutive patients were identified (63.2% men, median age 69 years). The 1-year risk of cardiovascular mortality between 2000 to 2002 and 2015 to 2017 decreased from 18.4% to 7.6%, whereas noncardiovascular mortality decreased from 5.8% to 5.0%. This corresponded to an increase in the proportion of total 1-year mortality attributed to noncardiovascular causes from 24.1% to 39.5%. Furthermore, increases in 1-year risk of incident cancer (1.9%-2.4%), incident renal disease (1.0%-1.6%), and infectious disease (5.5%-9.1%) were observed (all P trend <0.01). In analyses standardized for changes in patient characteristics, the increased risk of cancer in 2015 to 2017 compared with 2000 to 2002 was no longer significant (standardized risk ratios for cancer: 0.99 [95% CI: 0.91-1.07]; renal disease: 1.28 [95% CI: 1.15-1.41]; infectious disease: 1.28 [95% CI: 1.23-1.34]). CONCLUSIONS Although cardiovascular mortality following MI improved substantially during 2000 to 2017, the risk of noncardiovascular morbidity increased. Moreover, noncardiovascular causes constitute an increasing proportion of post-MI mortality. These findings suggest that further attention on noncardiovascular outcomes is warranted in guidelines and clinical practice and should be considered in the design of future clinical trials.
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Affiliation(s)
| | - Jarl Emanuel Strange
- Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark; Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Mohamad El-Chouli
- Danish Heart Foundation, Copenhagen, Denmark; Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | | | - Morten Malmborg
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Nina Nouhravesh
- Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - Gunnar Gislason
- Danish Heart Foundation, Copenhagen, Denmark; Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Thomas S G Sehested
- Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark
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10
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Yang S, Hwang D, Zhang J, Park J, Yun JP, Lee JM, Nam C, Shin E, Doh J, Chen S, Kakuta T, Toth GG, Piroth Z, Johnson NP, Hakeem A, Uretsky BF, Hokama Y, Tanaka N, Lim H, Ito T, Matsuo A, Azzalini L, Leesar MA, Neleman T, van Mieghem NM, Diletti R, Daemen J, Collison D, Collet C, De Bruyne B, Koo B. Clinical and Vessel Characteristics Associated With Hard Outcomes After PCI and Their Combined Prognostic Implications. J Am Heart Assoc 2023; 12:e030572. [PMID: 37642032 PMCID: PMC10547308 DOI: 10.1161/jaha.123.030572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023]
Abstract
Background Cardiac death or myocardial infarction still occurs in patients undergoing contemporary percutaneous coronary intervention (PCI). We aimed to identify adverse clinical and vessel characteristics related to hard outcomes after PCI and to investigate their individual and combined prognostic implications. Methods and Results From an individual patient data meta-analysis of 17 cohorts of patients who underwent post-PCI fractional flow reserve measurement after drug-eluting stent implantation, 2081 patients with available clinical and vessel characteristics were analyzed. The primary outcome was cardiac death or target-vessel myocardial infarction at 2 years. The mean age of patients was 64.2±10.2 years, and the mean angiographic percent diameter stenosis was 63.9%±14.3%. Among 11 clinical and 8 vessel features, 4 adverse clinical characteristics (age ≥65 years, diabetes, chronic kidney disease, and left ventricular ejection fraction <50%) and 2 adverse vessel characteristics (post-PCI fractional flow reserve ≤0.80 and total stent length ≥54 mm) were identified to independently predict the primary outcome (all P<0.05). The number of adverse vessel characteristics had additive predictability for the primary end point to that of adverse clinical characteristics (area under the curve 0.72 versus 0.78; P=0.03) and vice versa (area under the curve 0.68 versus 0.78; P=0.03). The cumulative event rate increased in the order of none, either, and both of adverse clinical characteristics ≥2 and adverse vessel characteristics ≥1 (0.3%, 2.4%, and 5.3%; P for trend <0.01). Conclusions In patients undergoing drug-eluting stent implantation, adverse clinical and vessel characteristics were associated with the risk of cardiac death or target-vessel myocardial infarction. Because these characteristics showed independent and additive prognostic value, their integrative assessment can optimize post-PCI risk stratification. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04684043. www.crd.york.ac.uk/prospero/. Unique Identifier: CRD42021234748.
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Affiliation(s)
- Seokhun Yang
- Department of Internal Medicine and Cardiovascular CenterSeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular CenterSeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
| | - Jinlong Zhang
- Department of CardiologyThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouChina
| | - Jiesuck Park
- Department of Internal Medicine and Cardiovascular CenterSeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
| | - Jun Pil Yun
- Department of Internal Medicine and Cardiovascular CenterSeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal MedicineHeart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
| | - Chang‐Wook Nam
- Department of MedicineKeimyung University Dongsan Medical CenterDaeguSouth Korea
| | - Eun‐Seok Shin
- Department of CardiologyUlsan University Hospital, University of Ulsan College of MedicineUlsanSouth Korea
| | - Joon‐Hyung Doh
- Department of MedicineInje University Ilsan Paik HospitalGoyangSouth Korea
| | - Shao‐Liang Chen
- Division of Cardiology, Nanjing First HospitalNanjing Medical UniversityNanjingChina
| | - Tsunekazu Kakuta
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalIbarakiJapan
| | - Gabor G. Toth
- University Heart Centre Graz, Medical University GrazGrazAustria
| | - Zsolt Piroth
- Gottsegen Hungarian Institute of CardiologyBudapestHungary
| | - Nils P. Johnson
- Division of Cardiology, Department of Medicine, Weatherhead PET Center For Preventing and Reversing AtherosclerosisUniversity of Texas Medical School and Memorial Hermann HospitalHoustonTX
| | - Abdul Hakeem
- Division of Cardiovascular Diseases & Hypertension, Robert Wood Johnson Medical SchoolRutgers UniversityNew BrunswickNJ
| | - Barry F Uretsky
- Central Arkansas VA Health System/University of Arkansas for Medical SciencesLittle RockAR
| | - Yohei Hokama
- Department of CardiologyTokyo Medical University Hachioji Medical CenterTokyoJapan
| | - Nobuhiro Tanaka
- Department of CardiologyTokyo Medical University Hachioji Medical CenterTokyoJapan
| | - Hong‐Seok Lim
- Department of CardiologyAjou University School of MedicineSuwonSouth Korea
| | - Tsuyoshi Ito
- Department of CardiologyNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Akiko Matsuo
- Department of CardiologyKyoto Second Red Cross HospitalKyotoJapan
| | - Lorenzo Azzalini
- Division of Cardiology, Department of MedicineUniversity of WashingtonSeattleWA
| | - Massoud A. Leesar
- Division of Cardiovascular DiseasesUniversity of AlabamaBirminghamAL
| | - Tara Neleman
- Department of Interventional CardiologyThoraxcenter, Erasmus University Medical CentreRotterdamThe Netherlands
| | - Nicolas M van Mieghem
- Department of Interventional CardiologyThoraxcenter, Erasmus University Medical CentreRotterdamThe Netherlands
| | - Roberto Diletti
- Department of Interventional CardiologyThoraxcenter, Erasmus University Medical CentreRotterdamThe Netherlands
| | - Joost Daemen
- Department of Interventional CardiologyThoraxcenter, Erasmus University Medical CentreRotterdamThe Netherlands
| | - Damien Collison
- West of Scotland Regional Heart and Lung Centre, Golden Jubilee National HospitalGlasgowUnited Kingdom
| | | | - Bernard De Bruyne
- Cardiovascular Center AalstAalstBelgium
- Department of CardiologyUniversity of LausanneSwitzerland
| | - Bon‐Kwon Koo
- Department of Internal Medicine and Cardiovascular CenterSeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
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11
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Bell CF, Lei X, Haas A, Baylis RA, Gao H, Luo L, Giordano SH, Wehner MR, Nead KT, Leeper NJ. Risk of Cancer After Diagnosis of Cardiovascular Disease. JACC CardioOncol 2023; 5:431-440. [PMID: 37614573 PMCID: PMC10443115 DOI: 10.1016/j.jaccao.2023.01.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 01/05/2023] [Accepted: 01/12/2023] [Indexed: 08/25/2023] Open
Abstract
Background Cardiovascular disease (CVD) and cancer share several risk factors. Although preclinical models show that various types of CVD can accelerate cancer progression, clinical studies have not determined the impact of atherosclerosis on cancer risk. Objectives The objective of this study was to determine whether CVD, especially atherosclerotic CVD, is independently associated with incident cancer. Methods Using IBM MarketScan claims data from over 130 million individuals, 27 million cancer-free subjects with a minimum of 36 months of follow-up data were identified. Individuals were stratified by presence or absence of CVD, time-varying analysis with multivariable adjustment for cardiovascular risk factors was performed, and cumulative risk of cancer was calculated. Additional analyses were performed according to CVD type (atherosclerotic vs nonatherosclerotic) and cancer subtype. Results Among 27,195,088 individuals, those with CVD were 13% more likely to develop cancer than those without CVD (HR: 1.13; 95% CI: 1.12-1.13). Results were more pronounced for individuals with atherosclerotic CVD (aCVD), who had a higher risk of cancer than those without CVD (HR: 1.20; 95% CI: 1.19-1.21). aCVD also conferred a higher risk of cancer compared with those with nonatherosclerotic CVD (HR: 1.11; 95% CI: 1.11-1.12). Cancer subtype analyses showed specific associations of aCVD with several malignancies, including lung, bladder, liver, colon, and other hematologic cancers. Conclusions Individuals with CVD have an increased risk of developing cancer compared with those without CVD. This association may be driven in part by the relationship of atherosclerosis with specific cancer subtypes, which persists after controlling for conventional risk factors.
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Affiliation(s)
- Caitlin F. Bell
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, Stanford, California, USA
- Stanford Cardiovascular Institute, Stanford, California, USA
| | - Xiudong Lei
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Allen Haas
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Richard A. Baylis
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, Stanford, California, USA
- Stanford Cardiovascular Institute, Stanford, California, USA
| | - Hua Gao
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, Stanford, California, USA
- Stanford Cardiovascular Institute, Stanford, California, USA
| | - Lingfeng Luo
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, Stanford, California, USA
- Stanford Cardiovascular Institute, Stanford, California, USA
| | - Sharon H. Giordano
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mackenzie R. Wehner
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kevin T. Nead
- Department of Epidemiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nicholas J. Leeper
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, Stanford, California, USA
- Stanford Cardiovascular Institute, Stanford, California, USA
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12
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Singh M, El Sabbagh A, Lewis BR, Kanwar A, Terzic CM, Al-Hijji MA, Behfar A, Kirkland JL. Clinical Significance of Biological Age in Patients Undergoing Percutaneous Coronary Intervention. Mayo Clin Proc 2023; 98:1137-1152. [PMID: 37536804 DOI: 10.1016/j.mayocp.2023.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 03/08/2023] [Accepted: 03/28/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE To test whether biological age calculated using deficits, functional impairments, or their combination will provide improved estimation of long-term mortality among older adults undergoing percutaneous coronary intervention. PATIENTS AND METHODS Cardiovascular deficits, noncardiovascular deficits, and functional impairments were prospectively studied in 535 patients aged 55 years or older from August 1, 2014, to March 31, 2018. Models for biological age included deficits (acquired, increase with age, associated with worse prognosis, did not saturate early), functional impairments (subjective-help with daily activities, difficulty with sensory input, continence, weight, balance, mobility; or objective-timed up and go, functional reach), or their combination. RESULTS The mean ± SD age of the study patients was 72.1±9.5 years. For every 5-year increase in chronological age, the mean number of cardiovascular deficits increased from 2.36 among patients younger than 70 years to 3.44 in nonagenarians. The mean number of functional impairments increased from 2.15 for those younger than 70 years to 6.74 for nonagenarians. During a median follow-up of 2.05 years, 99 patients died. Significant improvement in the Harrell concordance index (C index) for prediction of long-term all-cause mortality was noted with biological age calculated from deficits and impairments compared with chronological age (0.77 vs 0.65; P<.001) and when estimating biological age via functional impairments alone vs chronological age (0.75 vs 0.65; P<.001) but not via deficits alone (0.71 vs 0.65; P=.08). Biological age estimates from subjective functional impairments captured most of the prognostic information related to all-cause and noncardiac mortality, whereas deficit-based estimation favored cardiovascular mortality. CONCLUSION The derivation of biological age from deficits and functional impairments provides a major improvement in the estimation of survival as estimated by chronological age.
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Affiliation(s)
- Mandeep Singh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | | | - Bradley R Lewis
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Amrit Kanwar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Carmen M Terzic
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Atta Behfar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - James L Kirkland
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN
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13
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Navarese EP, Lansky AJ, Farkouh ME, Grzelakowska K, Bonaca MP, Gorog DA, Raggi P, Kelm M, Yeo B, Umińska J, Curzen N, Kubica J, Wijns W, Kereiakes DJ. Effects of Elective Coronary Revascularization vs Medical Therapy Alone on Noncardiac Mortality: A Meta-Analysis. JACC Cardiovasc Interv 2023; 16:1144-1156. [PMID: 37225285 DOI: 10.1016/j.jcin.2023.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Uncertainty exists whether coronary revascularization plus medical therapy (MT) is associated with an increase in noncardiac mortality in chronic coronary syndrome (CCS) when compared with MT alone, particularly following recent data from the ISCHEMIA-EXTEND (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial. OBJECTIVES This study conducted a large-scale meta-analysis of trials comparing elective coronary revascularization plus MT vs MT alone in patients with CCS to determine whether revascularization has a differential impact on noncardiac mortality at the longest follow-up. METHODS We searched for randomized trials comparing revascularization plus MT vs MT alone in patients with CCS. Treatment effects were measured by rate ratios (RRs) with 95% CIs, using random-effects models. Noncardiac mortality was the prespecified endpoint. The study is registered with PROSPERO (CRD42022380664). RESULTS Eighteen trials were included involving 16,908 patients randomized to either revascularization plus MT (n = 8,665) or to MT alone (n = 8,243). No significant differences were detected in noncardiac mortality between the assigned treatment groups (RR: 1.09; 95% CI: 0.94-1.26; P = 0.26), with absent heterogeneity (I2 = 0%). Results were consistent without the ISCHEMIA trial (RR: 1.00; 95% CI: 0.84-1.18; P = 0.97). By meta-regression, follow-up duration did not affect noncardiac death rates with revascularization plus MT vs MT alone (P = 0.52). Trial sequential analysis confirmed the reliability of meta-analysis, with the cumulative Z-curve of trial evidence within the nonsignificance area and reaching futility boundaries. Bayesian meta-analysis findings were consistent with the standard approach (RR: 1.08; 95% credible interval: 0.90-1.31). CONCLUSIONS In patients with CCS, noncardiac mortality in late follow-up was similar for revascularization plus MT compared with MT alone.
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Affiliation(s)
- Eliano P Navarese
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland; Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada; SIRIO MEDICINE Research Network, Bydgoszcz, Poland.
| | | | - Michael E Farkouh
- Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada; Cedars Sinai Health System, Los Angeles, CA
| | - Klaudyna Grzelakowska
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland; SIRIO MEDICINE Research Network, Bydgoszcz, Poland
| | - Marc P Bonaca
- CPC Clinical Research, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Diana A Gorog
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiology Department, East and North Hertfordshire NHS Trust, Stevenage, United Kingdom
| | - Paolo Raggi
- Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Malte Kelm
- Heinrich Heine University Medical Center Düsseldorf, Düsseldorf, Germany; Division of Cardiology, Pulmonology, and Vascular Medicine, Cardiovascular Research Institute Düsseldorf, Düsseldorf, Germany
| | - Brandon Yeo
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland; SIRIO MEDICINE Research Network, Bydgoszcz, Poland
| | - Julia Umińska
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland; SIRIO MEDICINE Research Network, Bydgoszcz, Poland
| | - Nick Curzen
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; University of Southampton, Southampton, United Kingdom
| | - Jacek Kubica
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland; SIRIO MEDICINE Research Network, Bydgoszcz, Poland
| | - William Wijns
- Lambe Institute for Translational Medicine and CÚRAM, National University of Ireland Galway and Saolta University Healthcare Group, Galway, Ireland
| | - Dean J Kereiakes
- Christ Hospital and Lindner Research Center, Cincinnati, Ohio, USA
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14
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Wakabayashi K, Higuchi S, Miyachi H, Minatsuki S, Ito R, Kondo S, Miyauchi K, Yamasaki M, Tanaka H, Yamashita J, Kishi M, Abe K, Mase T, Yahagi K, Asano T, Saji M, Iwata H, Mitsuhashi Y, Nagao K, Yamamoto T, Shinke T, Takayama M. Clinical features and predictors of non-cardiac death in patients hospitalised for acute myocardial infarction: Insights from the Tokyo CCU network multicentre registry. Int J Cardiol 2023; 378:1-7. [PMID: 36791966 DOI: 10.1016/j.ijcard.2023.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Patients with acute myocardial infarction (AMI) commonly have multiple comorbidities, and some die in hospitals due to causes other than cardiac complications. However, limited information is available on noncardiac death in patients hospitalised for AMI. Therefore, the present study was performed to determine the incidence, annual trend, clinical characteristics, and predictors of in-hospital non-cardiac death in patients with AMI using the Tokyo Cardiovascular Care Unit (CCU) network registry. METHODS The registry included 38,589 consecutive patients with AMI who were admitted to the CCU between 2010 and 2019. The primary endpoint was in-hospital noncardiac death. Further, predictors of cardiac and non-cardiac death were identified. RESULTS The incidence of all-cause in-hospital mortality was 7.0% (n = 2700), and the proportion of mortality was 15.6% (n = 420) and 84.4% (n = 2280) for noncardiac and cardiac causes, respectively. The proportion of noncardiac deaths did not change annually over the last decade (p = 0.66). After adjusting for all variables, age, Killip classification grade, peak creatine kinase, hemoglobin, serum creatinine, and C-reactive protein were common predictors of cardiac and non-cardiac deaths. Indicators of malnutrition, such as lower body mass index (kg/m2) [odds 0.94, 95%CI (0.90-0.97), p < 0.001] and serum low-density lipoprotein cholesterol level (per 10 mg/dl) [odds 0.92, 95%CI (0.89-0.96), p < 0.001] were the specific predictors for non-cardiac deaths. CONCLUSIONS The incidence of in-hospital noncardiac death was significant in patients with AMI, accounting for 15.6% of all in-hospital mortalities. Thus, prevention and management of non-cardiac complications are vital to improve acute-phase outcomes, especially those with predictors of non-cardiac death.
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Affiliation(s)
- Kohei Wakabayashi
- Tokyo CCU Network Scientific Committee, Tokyo, Japan; Division of Cardiology, Cardiovascular Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
| | | | | | | | - Ryosuke Ito
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Seita Kondo
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | | | | | - Jun Yamashita
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Mikio Kishi
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Kaito Abe
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Takaaki Mase
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | - Taku Asano
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Mike Saji
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Hiroshi Iwata
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
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15
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Rodriguez AE, Fernandez-Pereira C, Mieres JR, Rodriguez-Granillo AM. High Non-Cardiac Death Incidence Should Be a Limitation of Drug-Eluting Stents Implantation? Insights from Recent Randomized Data. Diagnostics (Basel) 2023; 13:diagnostics13071321. [PMID: 37046540 PMCID: PMC10093159 DOI: 10.3390/diagnostics13071321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/16/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
Despite the introduction of drug-eluting stents (DES) significantly improved the efficacy and safety of percutaneous coronary interventions (PCI), particularly in a high-risk group of patients, the gap between PCI with his competitor’s coronary artery bypass surgery (CABG) and/or optimal medical treatment alone was not reduced. In this revision, we highlighted the fact that in recent years landmark randomized studies reported at mid and long-term follow-ups a high incidence of non-cardiac death, cancer incidence, or both in the DES group of patients. The overall incidence of non-cardiac death was significantly higher in the DES vs. the comparator arm: 5.5% and 3.8%, respectively, p = 0.000018, and non-cardiac death appears to be more divergent between DES vs. the comparator at the extended follow-up to expenses of the last one. One of these trials reported five times greater cancer incidence in the DES arm at late follow-up, 5% vs. 0.7% p < 0.0018. We review the potential reason for these unexpected findings, although we can discard that DES biology could be involved in it. Until all these issues are resolved, we propose that DES implantation should be tailored accorded patient age, life expectancy, and lesion complexity.
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Affiliation(s)
- Alfredo E. Rodriguez
- Cardiac Unit, Otamendi Hospital, Post Graduate Buenos Aires School of Medicine, Cardiovascular Research Center (CECI), 868 Buenos Aires, Argentina
| | - Carlos Fernandez-Pereira
- Cardiac Unit, Otamendi Hospital, Post Graduate Buenos Aires School of Medicine, Cardiovascular Research Center (CECI), 868 Buenos Aires, Argentina
| | - Juan Ramon Mieres
- Cardiac Unit, Otamendi Hospital, Post Graduate Buenos Aires School of Medicine, Cardiovascular Research Center (CECI), 868 Buenos Aires, Argentina
| | - Alfredo Matias Rodriguez-Granillo
- Cardiac Unit, Otamendi Hospital, Post Graduate Buenos Aires School of Medicine, Cardiovascular Research Center (CECI), 868 Buenos Aires, Argentina
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16
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Widmer RJ, Exaire JE. Extending Our Knowledge of Lifetime Outcomes After ST-Elevation Myocardial Infarction. Am J Cardiol 2023; 191:139-140. [PMID: 36682925 DOI: 10.1016/j.amjcard.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/02/2023] [Indexed: 01/21/2023]
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17
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Ulvenstam A, Graipe A, Irewall AL, Söderström L, Mooe T. Incidence and predictors of cardiovascular outcomes after acute coronary syndrome in a population-based cohort study. Sci Rep 2023; 13:3447. [PMID: 36859606 PMCID: PMC9977928 DOI: 10.1038/s41598-023-30597-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 02/27/2023] [Indexed: 03/03/2023] Open
Abstract
There is limited data on long-term outcomes after hospitalization for ACS. We aimed to estimate the rate of recurrent cardiovascular events in the long-term, in a population-based, unselected cohort of ACS patients. We included 1379 patients with ACS hospitalized at Östersund hospital 2010-2014 and followed them from the day after discharge to 31 December 2017. The primary endpoint was the unadjusted rate of the composite of CV death, AMI and ischemic stroke. Risk factors for the primary endpoint were assessed in a multivariable Cox proportional hazards regression model. During a median follow-up of 4.7 years, the unadjusted rate of the primary endpoint was 10.3% at 1 year and 28.6% at the end of follow-up. Predictors of increased risk for subsequent events were congestive heart failure, diabetes mellitus, angina pectoris, prior revascularization with PCI or CABG and treatment with diuretics at discharge. Lipid-lowering therapy at discharge and revascularization with PCI or CABG were associated with a lower risk of recurrent events. The risk of recurrent cardiovascular was high at 1 year and continued to be so during the following almost 3 years of median follow-up. Established predictors of cardiovascular risk were confirmed.
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Affiliation(s)
- Anders Ulvenstam
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
| | - Anna Graipe
- grid.12650.300000 0001 1034 3451Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Anna-Lotta Irewall
- grid.12650.300000 0001 1034 3451Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lars Söderström
- grid.12650.300000 0001 1034 3451Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Thomas Mooe
- grid.12650.300000 0001 1034 3451Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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18
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Chen HH, Lo YC, Pan WS, Liu SJ, Yeh TL, Liu LYM. Association between coronary artery disease and incident cancer risk: a systematic review and meta-analysis of cohort studies. PeerJ 2023; 11:e14922. [PMID: 36855430 PMCID: PMC9968460 DOI: 10.7717/peerj.14922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/27/2023] [Indexed: 02/25/2023] Open
Abstract
Objective Coronary artery disease (CAD) and cancer are the two leading causes of death worldwide. Evidence suggests the existence of shared mechanisms for these two diseases. We aimed to conduct a systematic review and meta-analysis to investigateassociation between CAD and incident cancer risk. Methods We searched Cochrane, PubMed, and Embase from inception until October 20, 2021, without language restrictions. Observational cohort studies were used to investigate the association between CAD and incident cancer risk. Using random-effects models, the odds ratio (OR) and 95% confidence interval (CI) were calculated. We utilized subgroup and sensitivity analyses to determine the potential sources of heterogeneity and explore the association between CAD and specific cancers. This study was conducted under a pre-established, registered protocol on PROSPERO (CRD42022302507). Results We initially examined 8,533 articles, and included 14 cohort studies in our review, 11 of which were eligible for meta-analysis. Patients with CAD had significantly higher odds of cancer risk than those without CAD (OR = 1.15, 95% CI = [1.08-1.22], I2 = 66%). Subgroup analysis revealed that the incident cancer risk was significantly higher in both sexes and patients with CAD with or without myocardial infarction. Sensitivity analysis revealed that the risk remained higher in patients with CAD even after >1 year of follow-up (OR = 1.23, 95% CI = [1.08-1.39], I2 = 76%). Regarding the specific outcome, the incident risk for colorectal and lung cancers was significantly higher (OR = 1.06, 95% CI = [1.03-1.10], I2 = 10%, and OR = 1.36, 95% CI = [1.15-1.60], I2 = 90%, respectively) and that for breast cancer was lower (OR = 0.86, 95% CI = [0.77-0.97], I2 = 57%) in patients with CAD than in those without CAD. Conclusion CAD may be associated with incident cancer risk, particularly for lung and colorectal cancers, in men and women as well as patients with or without myocardial infarction. Early detection of new-onset cancer and detailed cancer surveillance programs should be implemented in patients with CAD to reduce cancer-related morbidity and mortality.
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Affiliation(s)
- Hsin-Hao Chen
- Department of Family Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, Taipei City, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Yi-Chi Lo
- Department of Medical Education and Research, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan
| | - Wei-Sheng Pan
- Department of Medical Education and Research, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan
| | - Shu-Jung Liu
- Department of Medical Library, MacKay Memorial Hospital, Tamsui Branch, New Taipei City, Taiwan
| | - Tzu-Lin Yeh
- Department of Family Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Lawrence Yu-Min Liu
- MacKay Junior College of Medicine, Nursing, and Management, Taipei City, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Division of Cardiology, Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan
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19
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Nakamaru R, Shiraishi Y, Niimi N, Ueda I, Ikemura N, Suzuki M, Noma S, Inohara T, Numasawa Y, Fukuda K, Kohsaka S. Time Trend in Incidence of Sudden Cardiac Death After Percutaneous Coronary Intervention from 2009 to 2017 (from the Japanese Multicenter Registry). Am J Cardiol 2023; 188:44-51. [PMID: 36470011 DOI: 10.1016/j.amjcard.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/14/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022]
Abstract
The advances in the integrated management of patients with coronary artery disease undergoing percutaneous coronary intervention (PCI) have reduced subsequent cardiovascular events. Nonetheless, sudden cardiac death (SCD) remains a major concern. Therefore, we aimed to investigate the time trend in SCD incidence after PCI and to identify the clinical factors contributing to SCD. From a prospective, multicenter cohort registry in Japan, 8,723 consecutive patients with coronary artery disease undergoing PCI between 2009 and 2017 were included. We evaluated the SCD incidence 2 years after PCI; all death events were adjudicated, and SCD was defined as unexpected death without a noncardiovascular cause in a previously stable patient within 24 hours from the onset. The Fine and Gray method was used to identify the factors associated with SCD. Overall, the mean age of the patients was 68.3 ± 11.3 years, and 1,173 patients (13.4%) had heart failure (HF). During the study period, the use of second-generation drug-eluting stents increased. The 2-year cumulative incidence of all-cause mortality and SCD was 4.29% and 0.45%, respectively. All-cause mortality remained stable during the study period (p for trend = 0.98), whereas the crude incidence of SCD tended to decrease over the study period (p for trend = 0.052). HF was the strongest predictor associated with the risk of SCD (crude incidence [vs non-HF] 2.13% vs 0.19%; p <0.001). In conclusion, the incidence of SCD after PCI decreased over the last decade, albeit the high incidence of SCD among patients with HF remains concerning.
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Affiliation(s)
- Ryo Nakamaru
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; Healthcare Quality Assessment, the University of Tokyo, Tokyo, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Nozomi Niimi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Nobuhiro Ikemura
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Suzuki
- Department of Cardiology National Hospital Organization Saitama Hospital, Saitama, Japan
| | - Shigetaka Noma
- Department of Cardiology Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Taku Inohara
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Numasawa
- Department of Cardiology Japanese Red Cross Ashikaga Hospital, Tochigi, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
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20
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De Silva K, Campbell T, Kumar S. PCI for Ischemic Left Ventricular Dysfunction. N Engl J Med 2023; 388:187. [PMID: 36630632 DOI: 10.1056/nejmc2214569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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21
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Aïdoud A, Gana W, Poitau F, Debacq C, Leroy V, Nkodo J, Poupin P, Angoulvant D, Fougère B. High Prevalence of Geriatric Conditions Among Older Adults With Cardiovascular Disease. J Am Heart Assoc 2023; 12:e026850. [PMID: 36628962 PMCID: PMC9939057 DOI: 10.1161/jaha.122.026850] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
As the population ages, the global cardiovascular disease burden will continue to increase, particularly among older adults. Increases in life expectancy and better cardiovascular care have significantly reshaped the epidemiology of cardiovascular disease and have created new patient profiles. The combination of older age, multiple comorbidities, polypharmacy, frailty, and adverse noncardiovascular outcomes is challenging our routine clinical practice in this field. In this review, we examine noncardiovascular factors that statistically interact in a relevant way with health status and quality of life in older people with cardiovascular disease. We focused on specific geriatric conditions (multimorbidity, polypharmacy, geriatric syndromes, and frailty) that are responsible for a major risk of functional decline and have an important impact on the overall prognosis in this patient population.
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Affiliation(s)
- Amal Aïdoud
- Division of Geriatric MedicineTours University HospitalToursFrance,EA4245 Transplantation, Immunologie, InflammationTours UniversityToursFrance
| | - Wassim Gana
- Division of Geriatric MedicineTours University HospitalToursFrance
| | - Fanny Poitau
- Division of Geriatric MedicineTours University HospitalToursFrance
| | - Camille Debacq
- Division of Geriatric MedicineTours University HospitalToursFrance
| | - Victoire Leroy
- Division of Geriatric MedicineTours University HospitalToursFrance,EA 7505 Education, Ethics, HealthTours UniversityToursFrance
| | | | - Pierre Poupin
- INSERM CIC 1415Tours University HospitalToursFrance,INSERM, SPHERE U1246Tours University, Nantes UniversityToursFrance
| | - Denis Angoulvant
- EA4245 Transplantation, Immunologie, InflammationTours UniversityToursFrance,Cardiology UnitTrousseau Hospital, Tours University HospitalToursFrance
| | - Bertrand Fougère
- Division of Geriatric MedicineTours University HospitalToursFrance,EA 7505 Education, Ethics, HealthTours UniversityToursFrance
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22
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Bradley SM, Gluckman TJ. If the Fates Allow: The Zero-Sum Game of ISCHEMIA-EXTEND. Circulation 2023; 147:20-22. [PMID: 36335920 DOI: 10.1161/circulationaha.122.063033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Steven M Bradley
- Allina Health Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (S.M.B.)
| | - Ty J Gluckman
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence Research Network, Portland, OR (T.J.G.)
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23
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Spaulding C. Peut-ton prédire la mort subite d’origine cardiaque? BULLETIN DE L'ACADÉMIE NATIONALE DE MÉDECINE 2023. [DOI: 10.1016/j.banm.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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24
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Fukase T, Dohi T, Nishio R, Takeuchi M, Takahashi N, Chikata Y, Endo H, Doi S, Nishiyama H, Okai I, Iwata H, Okazaki S, Miyauchi K, Daida H, Minamino T. Combined impacts of low apolipoprotein A-I levels and reduced renal function on long-term prognosis in patients with coronary artery disease undergoing percutaneous coronary intervention. Clin Chim Acta 2022; 536:180-190. [DOI: 10.1016/j.cca.2022.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 11/03/2022]
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25
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P2Y12 Inhibitor or Aspirin Following Dual Antiplatelet Therapy After Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2022; 15:2239-2249. [DOI: 10.1016/j.jcin.2022.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/28/2022] [Accepted: 08/09/2022] [Indexed: 11/06/2022]
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26
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Chen X, Zhao X, Wu H, Li L, Yang D, Si Y, Wang F, He Y, Shou J, Jiang Y, Chu W, Zhou B, Zeng C, Wang WE. Association of Nonalcoholic Fatty Liver Disease with Ventricular Tachycardia and Sinus Arrest in Patients with Non-ST-Segment Elevation Myocardial Infarction. Int Heart J 2022; 63:814-820. [PMID: 36104232 DOI: 10.1536/ihj.22-113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is an emerging driver of cardiac arrhythmias. However, the relationship between NAFLD and malignant arrhythmia in non-ST-segment elevation myocardial infarction (NSTEMI) patients is still unclear.In this study, 358 NSTEMI inpatients were enrolled. They all received 24-hour Holter monitoring after percutaneous coronary intervention. All inpatients were divided into two groups: the non-NAFLD group (236 cases, 65.9%) and the NAFLD group (122 cases, 34.1%). Compared with the non-NAFLD group, the NAFLD group had a significantly higher incidence of PVCs/hour > 5 (premature ventricular complexes, 32.0% versus 9.3%, P < 0.001), ventricular tachycardia (VT, 22.1% versus 5.9%, P < 0.001), and sinus arrest (SA, 7.4% versus 1.3%, P = 0.002). We found that NAFLD was closely associated with the occurrence of VT [unadjusted odds ratio (OR) 4.507, 95% confidence interval (CI) 2.263-8.974, P < 0.001] and SA (OR 6.186, 95%CI 1.643-23.291, P = 0.007). After adjusting for age, sex, body mass index, and other confounding factors, the above differences were still statistically significant (VT: OR 4.808, 95%CI 2.254-10.253, P < 0.001; SA: OR 9.589, 95%CI 2.027-45.367, P = 0.004).NAFLD is associated with the occurrence of VT and SA in NSTEMI patients. It indicates that NAFLD might be a risk factor for malignant arrhythmias in post-NSTEMI patients.
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Affiliation(s)
- Xiaokang Chen
- Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University)
| | - Xiaofang Zhao
- Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University)
| | - Hao Wu
- Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University)
| | - Liangpeng Li
- Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University)
| | - Dezhong Yang
- Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University)
| | - Yueqiao Si
- Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University)
| | - Feng Wang
- Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University)
| | - Yanji He
- Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University)
| | - Jialing Shou
- Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University)
| | - Yuanyuan Jiang
- Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University)
| | - Wei Chu
- Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University)
| | - Bingqing Zhou
- Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University)
| | - Chunyu Zeng
- Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University)
| | - Wei Eric Wang
- Department of Cardiology, Daping Hospital, Third Military Medical University (Army Medical University)
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27
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Nishiyama H, Funamizu T, Iwata H, Endo H, Chikata Y, Doi S, Wada H, Naito R, Ogita M, Kato Y, Okai I, Dohi T, Kasai T, Isoda K, Okazaki S, Miyauchi K, Minamino T. Low Apolipoprotein
A1
was associated with increased risk of cancer mortality in patients following percutaneous coronary intervention: A 10‐year follow‐up study. Int J Cancer 2022; 151:1482-1490. [PMID: 35796324 PMCID: PMC9540779 DOI: 10.1002/ijc.34164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/12/2022] [Accepted: 05/24/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Hiroki Nishiyama
- Department of Cardiovascular Biology and Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Takehiro Funamizu
- Department of Cardiovascular Biology and Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Hiroshi Iwata
- Department of Cardiovascular Biology and Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Hirohisa Endo
- Department of Cardiovascular Biology and Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Yuichi Chikata
- Department of Cardiovascular Biology and Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Shinichiro Doi
- Department of Cardiovascular Biology and Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Hideki Wada
- Department of Cardiology Juntendo University Shizuoka Hospital Shizuoka Japan
| | - Ryo Naito
- Department of Cardiovascular Biology and Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Manabu Ogita
- Department of Cardiology Juntendo University Shizuoka Hospital Shizuoka Japan
| | - Yoshiteru Kato
- Department of Cardiovascular Biology and Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Iwao Okai
- Department of Cardiovascular Biology and Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Biology and Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Biology and Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Kikuo Isoda
- Department of Cardiology Juntendo University Nerima Hospital Tokyo Japan
| | - Shinya Okazaki
- Department of Cardiovascular Biology and Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Katsumi Miyauchi
- Department of Cardiovascular Biology and Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine Juntendo University Graduate School of Medicine Tokyo Japan
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28
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Agarwal R, Aurora RG, Siswanto BB, Muliawan HS. The prognostic value of neutrophil-to-lymphocyte ratio across all stages of coronary artery disease. Coron Artery Dis 2022; 33:137-143. [PMID: 33826535 DOI: 10.1097/mca.0000000000001040] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The natural history of coronary heart disease (CAD) commonly begins with atherosclerosis, progressing to chronic coronary syndrome (CCS), acute coronary syndrome (ACS), and eventually, heart failure. Despite advancements in preventive and therapeutic strategies, there is room for further cardiovascular risk reduction. Recently, inflammation has emerged as a potential therapeutic target. The neutrophil-to-lymphocyte ratio (NLR) is a novel inflammatory biomarker which predicts poor prognosis in several conditions such as metabolic syndrome, sepsis, malignancy and CAD. In atherosclerosis, a high NLR predicts plaque vulnerability and severe stenosis. This is consistent with observations in CCS, where an elevated NLR predicts long-term major adverse cardiac events (MACEs). In ACS patients, high NLR levels are associated with larger infarct sizes and poor long-term outcomes. Possible reasons for this include failure of fibrinolysis, ischemia-reperfusion injury and in-stent restenosis, all of which are associated with raised NLR levels. Following myocardial infarction, an elevated NLR correlates with pathological cardiac remodeling which propagates chronic heart failure. Finally, in heart failure patients, an elevated NLR predicts long-term MACEs, mortality, and poor left ventricular assist device and transplant outcomes. Further studies must evaluate whether the addition of NLR to current risk-stratification models can better identify high-risk CAD patients.
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Affiliation(s)
- Raksheeth Agarwal
- Faculty of Medicine, Universitas Indonesia, Jl. Salemba Raya No.6, Kenari, Kec. Senen, Jakarta Pusat, DKI Jakarta
| | - Ruth G Aurora
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jl. Let. Jend. S. Parman Kav 87, Jakarta Barat, DKI Jakarta
| | - Bambang B Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jl. Let. Jend. S. Parman Kav 87, Jakarta Barat, DKI Jakarta
| | - Hary S Muliawan
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/Rumah Sakit Universitas Indonesia, Jl. Prof Bahder Djohan, Pondok Cina, Beji, Depok, Jawa Barat, Indonesia
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29
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Matsumura K, Kakiuchi Y, Tabuchi T, Takase T, Maruyama M, Ueno M, Nakazawa G. Cancer screening: Possibility of underscreening in older adult population with a history of cardiovascular disease. J Cardiol 2022; 80:133-138. [DOI: 10.1016/j.jjcc.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/03/2022] [Accepted: 02/23/2022] [Indexed: 11/29/2022]
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30
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Marijon E, Garcia R, Narayanan K, Karam N, Jouven X. OUP accepted manuscript. Eur Heart J 2022; 43:1457-1464. [PMID: 35139183 PMCID: PMC9009402 DOI: 10.1093/eurheartj/ehab903] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 11/24/2022] Open
Abstract
More than 40 years after the first implantable cardioverter-defibrillator (ICD) implantation, sudden cardiac death (SCD) still accounts for more than five million deaths worldwide every year. Huge efforts in the field notwithstanding, it is now increasingly evident that the current strategy of long-term prevention based on left ventricular ejection fraction as the key selection criterion is actually of very limited impact, also because the largest absolute numbers of SCD are encountered in the general population not known to be at risk. It has been recently reemphasized that SCD is often not so sudden, with almost half of the victims experiencing typical warning symptoms preceding the event. Importantly, heeded and prompt medical attention can dramatically improve survival. Essentially, such timely action increases the chances of the SCD event being witnessed by emergency medical services and provides the opportunity for early intervention. In addition, newer technologies incorporating digital data acquisition, transfer between interconnected devices, and artificial intelligence, should allow dynamic, real-time monitoring of diverse parameters and therefore better identification of subjects at short-term SCD risk. Along with warning symptoms, these developments allow a new approach of near-term prevention based on the hours and minutes preceding SCD. In the present review, we challenge the current paradigm of mid- and long-term prevention using ICD in patients at the highest risk of SCD, and introduce a complementary concept applicable to the entire population that would aim to pre-empt SCD by timely detection and intervention within the minutes or hours prior to the event.
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Affiliation(s)
- Eloi Marijon
- Corresponding author. Tel: +33 6 62 83 38 48, Fax: +33 1 56 09 30 47,
| | | | - Kumar Narayanan
- Université de Paris, PARCC, INSERM, F-75015 Paris, France
- Paris-Sudden Death Expertise Center (SDEC), Paris, France
- Cardiology Department, Medicover Hospitals, Hyderabad, India
| | - Nicole Karam
- Université de Paris, PARCC, INSERM, F-75015 Paris, France
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
- Paris-Sudden Death Expertise Center (SDEC), Paris, France
| | - Xavier Jouven
- Université de Paris, PARCC, INSERM, F-75015 Paris, France
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
- Paris-Sudden Death Expertise Center (SDEC), Paris, France
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31
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Navarese EP, Andreotti F. Cardiac mortality, adequate power, and objective inclusion of the entire evidence are key to accurately define the long-term effect of revascularisation vs. medical therapy alone in stable coronary syndromes. Eur Heart J 2021; 42:4699-4700. [PMID: 34545407 DOI: 10.1093/eurheartj/ehab677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Eliano P Navarese
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, M. Skłodowskiej-Curie Street No 9, Bydgoszcz 85-094, Poland.,Faculty of Medicine, Department of Cardiology, 11220 83rd Avenue NW, Edmonton, AB T6G 2B7, Canada.,SIRIO MEDICINE Research Network, M. Skłodowskiej-Curie Street No 9, Bydgoszcz 85-094, Poland
| | - Felicita Andreotti
- Dept of Cardiovascular Science, Fondazione Policlinico Universitario Gemelli IRCCS, Largo F. Vito 1, Rome 00168, Italy.,Catholic University Medical School, Largo F Vito 1, Rome 00168, Italy
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32
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Koch T, Lenz T, Joner M, Xhepa E, Koppara T, Wiebe J, Coughlan JJ, Aytekin A, Ibrahim T, Kessler T, Cassese S, Laugwitz KL, Schunkert H, Kastrati A, Kufner S. Ten-year clinical outcomes of polymer-free versus durable polymer new-generation drug-eluting stent in patients with coronary artery disease with and without diabetes mellitus : Results of the Intracoronary Stenting and Angiographic Results: Test Efficacy of Sirolimus- and Probucol- and Zotarolimus-Eluting Stents (ISAR-TEST 5) trial. Clin Res Cardiol 2021; 110:1586-1598. [PMID: 34156521 PMCID: PMC8484170 DOI: 10.1007/s00392-021-01854-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/07/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Very long-term outcomes according to diabetic status of patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) with new-generation drug-eluting stents (DES) are scant. Both, the durable polymer zotarolimus-eluting stent (DP-ZES), the first DES to gain FDA-approval for specific use in patients with diabetes mellitus, and the polymer-free sirolimus- and probucol-eluting stent (PF-SES), with a unique design that enables effective drug release without the need of a polymer offer the potential to enhance clinical long-term outcomes especially in patients with diabetes mellitus. METHODS We investigate 10-year clinical outcomes of the prespecified subgroups of patients with and without diabetes mellitus, randomly assigned to treatment with PF-SES versus DP-ZES in the ISAR-TEST 5 trial. The primary endpoint of interest was major adverse cardiac events (MACE), defined as the composite of all-cause death, any myocardial infarction or any revascularization. Further endpoints of interest were cardiac death, myocardial infarction related to the target vessel and target lesion revascularization as well as the individual components of the primary composite endpoint and the incidence of definite or probable stent thrombosis at 10 years. RESULTS This analysis includes a total of 3002 patients randomly assigned to PF-SES (n = 2002) or DP-ZES (n = 1000). Prevalence of diabetes mellitus was high and comparable, 575 Patients (28.7%) in PF-SES group and 295 patients (29.5%) in DP-ZES group (P = 0.66). At 10 years 53.5% of patients with diabetes mellitus and 68.5% of patients without diabetes mellitus were alive. Regarding major adverse cardiac events, PF-SES as compared to DP-ZES showed comparable event rates in patients with diabetes mellitus (74.8% vs. 79.6%; hazard ratio 0.86; 95% CI 0.73-1.02; P = 0.08) and in patients without diabetes (PF-SES 62.5% vs. DP-ZES 62.2%; hazard ratio 0.99; 95% CI 0.88-1.11; P = 0.88). CONCLUSION At 10 years, both new-generation DES show comparable clinical outcome irrespective of diabetic status or polymer strategy. Event rates after PCI in patients with diabetes mellitus are considerable higher than in patients without diabetes mellitus and continue to accrue over time. TRIAL REGISTRATION ClinicalTrials.gov, NCT00598533, Registered 10 January 2008, https://clinicaltrials.gov/ct2/show/NCT00598533?term=NCT00598533 Kaplan-Meier estimates of endpoints of interest for patients with vs. without diabetes mellitus treated with PF-SES vs. DP-ZES. Bar graphs: Kaplan-Meier estimates as percentages. PF-SES: polymer-free sirolimus-eluting stent; DP-ZES: durable polymer zotarolimus-eluting stent; DM: diabetes mellitus. Comparison of event rates of individual endpoints in patients with and without diabetes mellitus treated with PF-SES vs. DP-ZES all without statistically significant differences. Comparison of event rates of individual endpoints in overall patients with vs. without diabetes mellitus significantly different (P ≤ 0.01 for all comparisons).
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Affiliation(s)
- Tobias Koch
- Deutsches Herzzentrum München, Klinik Für Herz- Und Kreislauferkrankungen, an der Technischen Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Tobias Lenz
- Deutsches Herzzentrum München, Klinik Für Herz- Und Kreislauferkrankungen, an der Technischen Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Michael Joner
- Deutsches Herzzentrum München, Klinik Für Herz- Und Kreislauferkrankungen, an der Technischen Universität München, Lazarettstrasse 36, 80636, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Erion Xhepa
- Deutsches Herzzentrum München, Klinik Für Herz- Und Kreislauferkrankungen, an der Technischen Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Tobias Koppara
- 1. medizinische Klinik, Klinikum Rechts der Isar, Technische Universität, Munich, Germany
| | - Jens Wiebe
- Deutsches Herzzentrum München, Klinik Für Herz- Und Kreislauferkrankungen, an der Technischen Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - J J Coughlan
- Deutsches Herzzentrum München, Klinik Für Herz- Und Kreislauferkrankungen, an der Technischen Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Alp Aytekin
- Deutsches Herzzentrum München, Klinik Für Herz- Und Kreislauferkrankungen, an der Technischen Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Tareq Ibrahim
- 1. medizinische Klinik, Klinikum Rechts der Isar, Technische Universität, Munich, Germany
| | - Thorsten Kessler
- Deutsches Herzzentrum München, Klinik Für Herz- Und Kreislauferkrankungen, an der Technischen Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Klinik Für Herz- Und Kreislauferkrankungen, an der Technischen Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Karl-Ludwig Laugwitz
- 1. medizinische Klinik, Klinikum Rechts der Isar, Technische Universität, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Klinik Für Herz- Und Kreislauferkrankungen, an der Technischen Universität München, Lazarettstrasse 36, 80636, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Klinik Für Herz- Und Kreislauferkrankungen, an der Technischen Universität München, Lazarettstrasse 36, 80636, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Sebastian Kufner
- Deutsches Herzzentrum München, Klinik Für Herz- Und Kreislauferkrankungen, an der Technischen Universität München, Lazarettstrasse 36, 80636, Munich, Germany.
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Assessment of appropriate body mass index cut-off points for long-term mortality among ST-elevation myocardial infarction survivors in Asian population using machine learning algorithm. Heart Vessels 2021; 37:219-228. [PMID: 34365566 DOI: 10.1007/s00380-021-01916-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Abstract
Low body mass index (BMI) is a predictor of adverse events in patients with ST-elevated myocardial infarction (STEMI) in Western countries. Because the average BMI of Asians is significantly lower than that of the Western population, the appropriate cut-off BMI value and its role in long-term mortality are unclear in Asian patients. Between January 2006 and December 2017, 1215 patients who underwent percutaneous coronary intervention (PCI) for acute STEMI and were alive at discharge (mean age, 67.7 years; male, 75.4%) were evaluated. The cut-off BMI value, which could predict all-cause mortality within 10 years, was detected using a survival classification and regression tree (CART) model. The causes of death according to the BMI value were evaluated in each group. Based on the CART model, the patients were divided into three groups (BMI < 18 kg/m2: 54 patients, 18 kg/m2 ≤ BMI ≤ 20 kg/m2: 109 patients, and BMI > 20 kg/m2: 1052 patients). The BMI decreased with age; with an increased BMI, patients with dyslipidemia, diabetes mellitus, and smoking habit increased. During the study period (median, 4.9 years), 194 patients (26.8%) died (cardiac death, 59 patients; non-cardiac death, 135 patients). All-cause mortality was more frequent as the BMI decreased (BMI < 18 kg/m2; 72.8%, 18 kg/m2 ≤ BMI ≤ 20 kg/m2; 40.5%, and BMI > 20 kg/m2; 22.8%; log-rank p < 0.001). Non-cardiac deaths were more frequent than cardiac deaths in all groups, and the dominance of non-cardiac death was highest in the lowest BMI group. Cut-off BMI values of 18 kg/m2 and 20 kg/m2 can predict long-term mortality after PCI in Asian STEMI survivors, whose cut-off value is lower than that in the Western populations. The main causes of death in this cohort differed according to the BMI values.
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Fukuoka R, Kohsaka S, Shiraishi Y, Sawano M, Abe T, Levy WC, Nagatomo Y, Nishihata Y, Goda A, Kohno T, Kawamura A, Fukuda K, Yoshikawa T. Sudden cardiac death after acute decompensation in heart failure patients: implications of discharge haemoglobin levels. ESC Heart Fail 2021; 8:3917-3928. [PMID: 34323007 PMCID: PMC8497203 DOI: 10.1002/ehf2.13414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 11/19/2022] Open
Abstract
Aims Heart failure (HF) patients have a high risk of mortality due to sudden cardiac death (SCD) and non‐SCD, including pump failure death (PFD). Anaemia predicts more severe symptomatic burden and higher morbidity, as noted by markedly increased hospitalizations and readmission rates, and mortality, underscoring its importance in HF management. Herein, we aimed to determine whether haemoglobin (Hb) level at discharge affects the mode of death and influences SCD risk prediction. Methods We evaluated the data of 3020 consecutive acute HF patients from a Japanese prospective multicentre registry. Patients were divided into four groups based on discharge Hb levels. SCD was defined as an unexpected and otherwise unexplained death in a previously stable patient or death due to documented or presumed cardiac arrhythmia without a clear non‐cardiovascular cause. The mode of death (SCD, PFD or other cause) was adjudicated by a central committee. Finally, we investigated whether adding Hb level to the Seattle Proportional Risk Model (SPRM; established risk score utilized to estimate ‘proportion’ of SCD among death events) would affect its performance. Results The mean age of studied patients was 74.3 ± 12.9 years, and 59.8% were male. The mean Hb level was 12.0 ± 2.1 g/dL (61.3% of patients had anaemia defined by World Health Organization criteria). During the 2‐year follow‐up, 474 deaths (15.7%) occurred, including 93 SCDs (3.1%), 171 PFDs (5.7%) and 210 other deaths (7.0%; predominantly non‐cardiac death). Absolute risk of PFD (P < 0.001) or other death (P < 0.001) increased along with the severity of anaemia, whereas the incidence of SCD was low but remained consistent across all four groups (P = 0.440). As a proportion of total deaths in each Hb level group, the contributions from non‐SCD increased and from SCD decreased along with anaemia severity (P = 0.007). Adding Hb level to the SPRM improved the overall discrimination (c‐index: 0.62 [95% confidence interval (CI) 0.56–0.69] to 0.65 [95% CI 0.59–0.71]), regardless of the baseline ejection fraction (EF) (c‐index: 0.64 [95% CI 0.55–0.73] to 0.67 [95% CI 0.58–0.75] for reduced EF and 0.55 [95% CI 0.45–0.66] to 0.61 [95% CI 0.52–0.70] for preserved EF). Conclusions The discharge Hb level provides information about both absolute and proportional risks for each mode of death in acute HF patients, and the addition of Hb level improves the performance of SPRM by identifying more non‐SCD cases. Future ‘proportional’ SCD risk models should incorporate Hb level as a covariate to meet this high performance.
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Affiliation(s)
- Ryoma Fukuoka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.,Department of Cardiology, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Takayuki Abe
- School of Data Science, Yokohama City University, Yokohama, Japan
| | - Wayne C Levy
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College, Tokorozawa, Japan
| | - Yosuke Nishihata
- Department of Cardiology, Cardiovascular Centre, St. Luke's International Hospital, Tokyo, Japan
| | - Ayumi Goda
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Takashi Kohno
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Akio Kawamura
- Department of Cardiology, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Navarese EP, Kereiakes DJ, Gorog DA, Lansky AJ, Andreotti F. When a meta-analysis equals a single large-scale trial with meaningful follow-up. Eur Heart J 2021; 42:3884-3885. [PMID: 34304265 DOI: 10.1093/eurheartj/ehab460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Eliano P Navarese
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland.,Faculty of Medicine, University of Alberta, Edmonton, Canada.,SIRIO MEDICINE Research Network, Poland
| | - Dean J Kereiakes
- Christ Hospital and Lindner Research Center, Cincinnati, OH, USA
| | - Diana A Gorog
- Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, UK.,Postgraduate Medical School, University of Hertfordshire, Hatfield, UK
| | | | - Felicita Andreotti
- Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy.,Catholic University Medical School, Rome, Italy
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Sawano M, Kohsaka S, Ishii H, Numasawa Y, Yamaji K, Inohara T, Amano T, Ikari Y, Nakamura M. One-Year Outcome After Percutaneous Coronary Intervention for Acute Coronary Syndrome - An Analysis of 20,042 Patients From a Japanese Nationwide Registry. Circ J 2021; 85:1756-1767. [PMID: 34162778 DOI: 10.1253/circj.cj-21-0098] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Acute coronary syndrome (ACS) hospital survivors experience a wide array of late adverse cardiac events, despite considerable advances in the quality of care. We investigated 30-day and 1-year outcomes of ACS hospital survivors using a Japanese nationwide cohort.Methods and Results:We studied 20,042 ACS patients who underwent percutaneous coronary intervention (PCI) in 2017: 10,242 (51%) with ST-elevation myocardial infarction (STEMI), 3,027 (15%) with non-ST-elevation myocardial infarction (NSTEMI), and 6,773 (34%) with unstable angina (UA). The mean (±SD) age was 69.6±12.4 years, 77% of the patients were men, and 20% had a previous history of PCI. The overall 30-day all-cause, cardiac, and non-cardiac mortality rates were 3.0%, 2.4%, and 0.6%, respectively. The overall 1-year incidence of all-cause, cardiac, and non-cardiac death was 7.1%, 4.2%, and 2.8%, respectively. Compared with UA patients, STEMI patients had a higher risk of all fatal events, non-fatal ischemic stroke, and acute heart failure, and NSTEMI patients had a higher risk of heart failure. CONCLUSIONS The results from our ACS hospital survivor PCI database suggest the need to improve care for the acute myocardial infarction population to lessen the burden of 30-day mortality due to ACS, heart failure, and sudden cardiac death, as well as 1-year ischemic stroke and heart failure events.
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Affiliation(s)
- Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Hideki Ishii
- Department of Cardiology, Fujita Health University Bantane Hospital
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital
| | | | - Taku Inohara
- Department of Cardiology, Keio University School of Medicine
| | | | - Yuji Ikari
- Department of Cardiovascular Medicine, Tokai University
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
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Lenz T, Koch T, Joner M, Xhepa E, Wiebe J, Coughlan JJ, Aytekin A, Ibrahim T, Fusaro M, Cassese S, Laugwitz KL, Schunkert H, Kastrati A, Kufner S. Ten-Year Clinical Outcomes of Biodegradable Versus Durable Polymer New-Generation Drug-Eluting Stent in Patients With Coronary Artery Disease With and Without Diabetes Mellitus. J Am Heart Assoc 2021; 10:e020165. [PMID: 34075784 PMCID: PMC8477883 DOI: 10.1161/jaha.120.020165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Extended long‐term follow‐up data of new‐generation drug‐eluting stents in patients with diabetes mellitus is scant. The aim of this study is to assess the 10‐year clinical outcome of new‐generation biodegradable polymer‐based sirolimus‐eluting stents (Yukon Choice PC) versus permanent polymer‐based everolimus‐eluting stents (XIENCE) in patients with and without diabetes mellitus. Methods and Results In a prespecified subgroup analysis, outcomes of patients with or without diabetes mellitus treated with drug‐eluting stents were compared. The primary end point of this analysis was major adverse cardiac event, the composite of death, myocardial infarction, or target lesion revascularization. The analysis includes a total of 1951 patients (560 patients with and 1391 patients without diabetes mellitus) randomized to treatment with Yukon Choice PC (n=1299) or Xience (n=652). Regarding the primary end point, at 10 years patients with diabetes mellitus showed significantly higher major adverse cardiac event rates than patients without diabetes mellitus (P<0.001; hazard ratio [HR], 1.41; 95% CI, 1.22–1.63). There was no significant difference between patients treated with Yukon Choice PC versus Xience, neither in the subgroup of patients with (P=0.91; HR, 1.01; 95% CI, 0.79–1.30) nor without diabetes mellitus (P=0.50; HR, 0.94; 95% CI, 0.79–1.21). Rates of definite/probable stent thrombosis were 2.3% in patients with and 1.9% in patients without diabetes mellitus (HR, 1.27; 95% CI, 0.34–2.60; P=0.52), without significant differences between study devices. Conclusions The clinical outcome of patients with diabetes after percutaneous coronary intervention with different new‐generation drug‐eluting stents is considerably worse than that of patients without diabetes mellitus, with event rates constantly increasing out to 10 years. Registration URL: https://clinicaltrials.gov. Unique Identifier: NCT00598676.
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Affiliation(s)
- Tobias Lenz
- Deutsches Herzzentrum Muenchen an der Technische Universität Muenchen Klinik für Herz- und Kreislauferkrankungen Munich Germany
| | - Tobias Koch
- Deutsches Herzzentrum Muenchen an der Technische Universität Muenchen Klinik für Herz- und Kreislauferkrankungen Munich Germany
| | - Michael Joner
- Deutsches Herzzentrum Muenchen an der Technische Universität Muenchen Klinik für Herz- und Kreislauferkrankungen Munich Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Erion Xhepa
- Deutsches Herzzentrum Muenchen an der Technische Universität Muenchen Klinik für Herz- und Kreislauferkrankungen Munich Germany
| | - Jens Wiebe
- Deutsches Herzzentrum Muenchen an der Technische Universität Muenchen Klinik für Herz- und Kreislauferkrankungen Munich Germany
| | - J J Coughlan
- Deutsches Herzzentrum Muenchen an der Technische Universität Muenchen Klinik für Herz- und Kreislauferkrankungen Munich Germany
| | - Alp Aytekin
- Deutsches Herzzentrum Muenchen an der Technische Universität Muenchen Klinik für Herz- und Kreislauferkrankungen Munich Germany
| | - Tareq Ibrahim
- Medizinische Klinik Klinikum rechts der Isar Technische Universität München Munich Germany
| | - Massimiliano Fusaro
- Deutsches Herzzentrum Muenchen an der Technische Universität Muenchen Klinik für Herz- und Kreislauferkrankungen Munich Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum Muenchen an der Technische Universität Muenchen Klinik für Herz- und Kreislauferkrankungen Munich Germany
| | - Karl-Ludwig Laugwitz
- Medizinische Klinik Klinikum rechts der Isar Technische Universität München Munich Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum Muenchen an der Technische Universität Muenchen Klinik für Herz- und Kreislauferkrankungen Munich Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum Muenchen an der Technische Universität Muenchen Klinik für Herz- und Kreislauferkrankungen Munich Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Sebastian Kufner
- Deutsches Herzzentrum Muenchen an der Technische Universität Muenchen Klinik für Herz- und Kreislauferkrankungen Munich Germany
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Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, Dendale P, Dorobantu M, Edvardsen T, Folliguet T, Gale CP, Gilard M, Jobs A, Jüni P, Lambrinou E, Lewis BS, Mehilli J, Meliga E, Merkely B, Mueller C, Roffi M, Rutten FH, Sibbing D, Siontis GC. Guía ESC 2020 sobre el diagnóstico y tratamiento del síndrome coronario agudo sin elevación del segmento ST. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Yoshioka N, Takagi K, Tanaka A, Morita Y, Yoshida R, Kanzaki Y, Nagai H, Watanabe N, Yamauchi R, Komeyama S, Sugiyama H, Shimojo K, Imaoka T, Sakamoto G, Ohi T, Goto H, Ishii H, Morishima I, Murohara T. The Mid-term Mortality and Mode of Death in Survivors with ST-elevation Myocardial Infarction. Intern Med 2021; 60:1665-1674. [PMID: 33390500 PMCID: PMC8222117 DOI: 10.2169/internalmedicine.6549-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective The popularity of primary percutaneous coronary intervention (p-PCI) for ST-elevation myocardial infarction (STEMI) has increased over the past decades. Despite improvements in in-hospital mortality rates, it is clinically important to investigate the prognoses after discharge. However, data on the mode of death and prognostic factors are limited. We analyzed these factors in a Japanese cohort in the modern p-PCI era. Methods Between January 2004 and December 2017, a total of 1,222 patients who underwent p-PCI within 24 hours from the onset of STEMI and were alive at discharge (mean age, 67.7 years old; men, 75.5%), were evaluated. The two-year mortality was analyzed using a Cox regression model, and the mode of death was evaluated. Results The rate of mortality at 2 years was 5.7%. Non-cardiac death was more frequent than cardiac death (62.6% vs. 37.4%). A Cox multivariate analysis identified the following as independent predictors of the 2-year mortality: hemoglobin (log-transformed) [adjusted hazard ratio (HR), 0.048; 95% confidence interval (CI), 0.008-0.29; p<0.001], age above 80 years old (adjusted HR, 2.26; 95% CI, 1.30-3.91; p=0.004), Killip class ≥II (adjusted HR, 1.99; 95% CI, 1.17-3.39; p=0.011), brain natriuretic peptide level (log-transformed) (adjusted HR, 1.47; 95% CI, 1.09-2.01; p=0.013), and body mass index (log-transformed) (adjusted HR, 0.16; 95% CI, 0.030-0.84; p=0.030). Conclusion This study demonstrated that the 2-year mortality was 5.7% in STEMI survivors after p-PCI. Non-cardiac death was more frequent than cardiac death. Compared to well-known clinical variables, angiographic findings did not have a significant influence on the mid-term mortality.
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Affiliation(s)
- Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, Japan
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Japan
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | | | - Ruka Yoshida
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | | | - Hiroaki Nagai
- Department of Cardiology, Ogaki Municipal Hospital, Japan
| | - Naoki Watanabe
- Department of Cardiology, Ogaki Municipal Hospital, Japan
| | - Ryota Yamauchi
- Department of Cardiology, Ogaki Municipal Hospital, Japan
| | | | | | - Kazuki Shimojo
- Department of Cardiology, Ogaki Municipal Hospital, Japan
| | - Takuro Imaoka
- Department of Cardiology, Ogaki Municipal Hospital, Japan
| | - Gaku Sakamoto
- Department of Cardiology, Ogaki Municipal Hospital, Japan
| | - Takuma Ohi
- Department of Cardiology, Ogaki Municipal Hospital, Japan
| | - Hiroki Goto
- Department of Cardiology, Ogaki Municipal Hospital, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
| | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
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Ford I, Robertson M, Greenlaw N, Bauters C, Lemesle G, Sorbets E, Ferrari R, Tardif JC, Tendera M, Fox K, Steg PG. Simple risk models to predict cardiovascular death in patients with stable coronary artery disease. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 7:287-294. [PMID: 31922541 PMCID: PMC8092988 DOI: 10.1093/ehjqcco/qcz070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/20/2019] [Accepted: 01/06/2020] [Indexed: 11/12/2022]
Abstract
AIMS Risk estimation is important to motivate patients to adhere to treatment and to identify those in whom additional treatments may be warranted and expensive treatments might be most cost effective. Our aim was to develop a simple risk model based on readily available risk factors for patients with stable coronary artery disease (CAD). METHODS AND RESULTS Models were developed in the CLARIFY registry of patients with stable CAD, first incorporating only simple clinical variables and then with the inclusion of assessments of left ventricular function, estimated glomerular filtration rate, and haemoglobin levels. The outcome of cardiovascular death over ∼5 years was analysed using a Cox proportional hazards model. Calibration of the models was assessed in an external study, the CORONOR registry of patients with stable coronary disease. We provide formulae for calculation of the risk score and simple integer points-based versions of the scores with associated look-up risk tables. Only the models based on simple clinical variables provided both good c-statistics (0.74 in CLARIFY and 0.80 or over in CORONOR), with no lack of calibration in the external dataset. CONCLUSION Our preferred model based on 10 readily available variables [age, diabetes, smoking, heart failure (HF) symptom status and histories of atrial fibrillation or flutter, myocardial infarction, peripheral arterial disease, stroke, percutaneous coronary intervention, and hospitalization for HF] had good discriminatory power and fitted well in an external dataset. STUDY REGISTRATION The CLARIFY registry is registered in the ISRCTN registry of clinical trials (ISRCTN43070564).
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Affiliation(s)
- Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Level 11, Boyd Orr Building, Glasgow G12 8QQ, UK
| | - Michele Robertson
- Robertson Centre for Biostatistics, University of Glasgow, Level 11, Boyd Orr Building, Glasgow G12 8QQ, UK
| | - Nicola Greenlaw
- Robertson Centre for Biostatistics, University of Glasgow, Level 11, Boyd Orr Building, Glasgow G12 8QQ, UK
| | - Christophe Bauters
- Cardiology Department, Institut Coeur Poumon, CHU, Université de Lille, Bd du Professeur Jules Leclercq, 59000 Lille, France
| | - Gilles Lemesle
- Cardiology Department, Institut Coeur Poumon, CHU, Université de Lille, Bd du Professeur Jules Leclercq, 59000 Lille, France
| | - Emmanuel Sorbets
- National Heart and Lung Institute, Imperial College, Dovehouse Street London SW3 6LY, UK
- Royal Brompton Hospital, Sydney St, London SW3 6NP, UK
- FACT (French Alliance for Cardiovascular Trials), Université de Paris, and AP-HP, Hopital Bichat, INSERM U1148, 46 rue Henri Huchard 75018 Paris, France
- Université de Paris 13, Sorbonne Paris Cité, AP-HP, Hôpital Avicenne, Bobigny, France
- Université de Paris, AP-HP, Hôtel-Dieu, Centre de Diagnostic et de thérapeutique, 1 rue de la Cité, 75004 Paris, France
| | - Roberto Ferrari
- Centro Cardiologico Universitario di Ferrara, University of Ferrara, Maria Cecilia Hospital, GVM Care & Research, Via Corriera, 1 48010 Cotignola, Ravenna, Italy
| | - Jean-Claude Tardif
- Montreal Heart Institute, 5000 Belanger Street, Montreal, H1T1C8, Université de Montréal, Canada
| | - Michal Tendera
- Department of Cardiology and Structural Heart Disease, Medical School in Katowice, Medical University of Silesia, Ziolowa Str. 45/47, 40-635 Katowice, Poland
| | - Kim Fox
- National Heart and Lung Institute, Imperial College, Dovehouse Street London SW3 6LY, UK
- Royal Brompton Hospital, Sydney St, London SW3 6NP, UK
| | - Philippe Gabriel Steg
- National Heart and Lung Institute, Imperial College, Dovehouse Street London SW3 6LY, UK
- Royal Brompton Hospital, Sydney St, London SW3 6NP, UK
- FACT (French Alliance for Cardiovascular Trials), Université de Paris, and AP-HP, Hopital Bichat, INSERM U1148, 46 rue Henri Huchard 75018 Paris, France
- Université de Paris 13, Sorbonne Paris Cité, AP-HP, Hôpital Avicenne, Bobigny, France
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Carnero Alcazar M, Hernandez-Vaquero D, Cubero-Gallego H, Lopez Menendez J, Piñon M, Albors Martin J, Cuerpo Caballero G, Cobiella Carnicer J, Villamor C, Forteza A, Pascual I, Maroto Castellanos LC. Retrospective cohort analysis of Spanish national trends of coronary artery bypass grafting and percutaneous coronary intervention from 1998 to 2017. BMJ Open 2021; 11:e046141. [PMID: 33827845 PMCID: PMC8031703 DOI: 10.1136/bmjopen-2020-046141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/18/2021] [Accepted: 03/08/2021] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Spain is one of the countries with the lowest rates of revascularisation and highest ratio of percutaneous coronary intervention (PCI) to coronary artery bypass grafting (CABG). OBJECTIVES To investigate the changes and trends in the two revascularisation procedures between 1998 and 2017 in Spain. DESIGN Retrospective cohort study. Analysis of in-hospital outcomes. SETTING Minimum basic data set from the Spanish National Department of Health: mandatory database collecting information of patients who are attended in the Spanish public National Health System. PARTICIPANTS 603 976 patients who underwent isolated CABG or PCI in the Spanish National Health System. The study period was divided in four 5-year intervals. Patients with acute myocardial infarction on admission were excluded. PRIMARY AND SECONDARY OUTCOMES We investigated the volume of procedures nationwide, the changes of the risk profile of patients and in-hospital mortality of both techniques. RESULTS We observed a 2.2-fold increase in the rate of any type of myocardial revascularisation per million inhabitants-year: 357 (1998) to 776 (2017). 93 682 (15.5%) had a coronary surgery. PCI to CABG ratio rose from 2.2 (1998-2002) to 8.1 (2013-2017). Charlson's index increased by 0.8 for CABG and 1 for PCI. The median annual volume of PCI/hospital augmented from 136 to 232, while the volume of CABG was reduced from 137 to 74. In the two decades, we detected a significant reduction of CABG in-hospital mortality (6.5% vs 2.6%, p<0.001) and a small increase in PCI (1.2% vs 1.5%, p<0.001). Risk adjusted mortality rate was reduced for both CABG (1.51 vs 0.48, p<0.001), and PCI (1.42 vs 1.05, p<0.001). CONCLUSION We detected a significant increase in the volume of revascularisations (particularly PCI) in Spain. Risk-adjusted in-hospital mortality was significantly reduced.
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Affiliation(s)
- Manuel Carnero Alcazar
- Cardiac Surgery, Hospital Clínico Universitario San Carlos Instituto Cardiovascular, Madrid, Comunidad de Madrid, Spain
| | | | - Hector Cubero-Gallego
- Cardiology, Unit of Interventional Cardiology, Hospital del Mar, Barcelona, Catalunya, Spain
| | | | - Miguel Piñon
- Cardiac Surgery, Alvaro Cunqueiro Hospital, Vigo, Galicia, Spain
| | - Jose Albors Martin
- Cardiac Surgery, Hospital Universitario del Vinalopó, Elche, Alicante, Spain
| | | | - Javier Cobiella Carnicer
- Cardiac Surgery, Hospital Clínico Universitario San Carlos Instituto Cardiovascular, Madrid, Comunidad de Madrid, Spain
| | - Cristina Villamor
- Internal Medicine, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - Alberto Forteza
- Cadiac Surgery, Puerta del Hierro University Hospital of Majadahonda, Majadahonda, Madrid, Spain
| | - Isaac Pascual
- Cardiology, Unit of Interventional Cardiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, Dendale P, Dorobantu M, Edvardsen T, Folliguet T, Gale CP, Gilard M, Jobs A, Jüni P, Lambrinou E, Lewis BS, Mehilli J, Meliga E, Merkely B, Mueller C, Roffi M, Rutten FH, Sibbing D, Siontis GCM. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021; 42:1289-1367. [PMID: 32860058 DOI: 10.1093/eurheartj/ehaa575] [Citation(s) in RCA: 2686] [Impact Index Per Article: 895.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Agasthi P, Chao CJ, Wang P, Yang EH, Arsanjani R. National Cardiovascular Data Registry Model Predicts Long-Term Mortality in Patients Undergoing Percutaneous Coronary Interventions. Cardiology 2021; 146:311-314. [PMID: 33735875 DOI: 10.1159/000512419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/19/2020] [Indexed: 11/19/2022]
Abstract
National Cardiovascular Data Registry (NCDR)-based logistic regression model is available for clinicians to predict in-hospital all-cause mortality after a percutaneous coronary intervention (PCI). However, this model has never been used to predict long-term all-cause mortality after PCI. Therefore, we sought to test the ability of the NCDR model to predict the short- and long-term risk of all-cause mortality in patients undergoing PCI. All patients undergoing PCI in the Mayo Clinic Health System were enrolled in the Mayo Clinic CathPCI registry. Patient-level demographic, clinical, and angiographic data from January 2006 to December 2017 were extracted from the registry. Patients who underwent coronary artery bypass graft surgery (CABG) were excluded. The area under the receiver operator characteristic curve (AUC) was calculated to assess the ability of the NCDR model to predict outcomes of interest (6-month, 1-year, 2-year, and 5-year all-cause mortality) after PCI. A total of 17,356 unique patients were included for the final analysis after excluding 165 patients who underwent CABG surgery. The mean age was 66.9 ± 12.5 years, and 71% were men. The 6-month, 1-year, 2-year, and 5-year all-cause mortality rates were 4.2% (n = 737), 5.8% (n = 1,005), 8.06% (n = 1,399), and 14.2% (n = 2,472), respectively. The AUCs of the NCDR model to predict 6-month, 1-year, 2-year, and 5-year all-cause mortality were 0.84 (95% CI: 0.82-0.86), 0.82 (95% CI: 0.80-0.84), 0.80 (95% CI: 0.79-0.81), and 0.78 (95% CI: 0.77-0.79), respectively. The NCDR model was able to accurately predict both short- and long-term all-cause mortality after PCI.
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Affiliation(s)
- Pradyumna Agasthi
- Department of Cardiovascular Disease, Mayo Clinic, Phoenix, Arizona, USA,
| | - Chieh-Ju Chao
- Department of Cardiovascular Disease, Mayo Clinic, Phoenix, Arizona, USA
| | - Panwen Wang
- Department of Health Sciences Research, Mayo Clinic, Phoenix, Arizona, USA
| | - Eric H Yang
- Department of Cardiovascular Disease, Mayo Clinic, Phoenix, Arizona, USA
| | - Reza Arsanjani
- Department of Cardiovascular Disease, Mayo Clinic, Phoenix, Arizona, USA
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Brugaletta S, Gomez-Lara J, Ortega-Paz L, Jimenez-Diaz V, Jimenez M, Jiménez-Quevedo P, Diletti R, Mainar V, Campo G, Silvestro A, Maristany J, Flores X, Oyarzabal L, De Miguel-Castro A, Iñiguez A, Serra A, Nombela-Franco L, Ielasi A, Tespili M, Lenzen M, Gonzalo N, Bordes P, Tebaldi M, Biscaglia S, Rodriguez-Arias JJ, Al-Shaibani S, Arevalos V, Romaguera R, Gomez-Hospital JA, Serruys PW, Sabaté M. 10-Year Follow-Up of Patients With Everolimus-Eluting Versus Bare-Metal Stents After ST-Segment Elevation Myocardial Infarction. J Am Coll Cardiol 2021; 77:1165-1178. [PMID: 33663733 DOI: 10.1016/j.jacc.2020.12.059] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Outcomes data for a durable-polymer everolimus-eluting stent (EES) at extended long-term follow-up in patients with ST-segment elevation myocardial infarction (STEMI) are unknown. OBJECTIVES The aim of this study was to assess the 10-year outcomes of patients enrolled in the EXAMINATION (A Clinical Evaluation of Everolimus Eluting Coronary Stents in the Treatment of Patients With ST-Segment Elevation Myocardial Infarction) trial. METHODS The EXAMINATION-EXTEND (10-Years Follow-Up of the EXAMINATION Trial) study is an investigator-driven 10-year follow-up of the EXAMINATION trial, which randomly assigned 1,498 patients with STEMI in a 1:1 ratio to receive either EES (n = 751) or bare-metal stents (n = 747). The primary endpoint was a patient-oriented composite endpoint of all-cause death, any myocardial infarction, or any revascularization. Secondary endpoints included a device-oriented composite endpoint of cardiac death, target vessel myocardial infarction, or target lesion revascularization; the individual components of the combined endpoints; and stent thrombosis. RESULTS Complete 10-year clinical follow-up was obtained in 94.5% of the EES group and 95.9% of the bare-metal stent group. Rates of the patient-oriented composite endpoint and device-oriented composite endpoint were significantly reduced in the EES group (32.4% vs. 38.0% [hazard ratio: 0.81; 95% confidence interval: 0.68 to 0.96; p = 0.013] and 13.6% vs. 18.4% [hazard ratio: 0.72; 95% confidence interval: 0.55 to 0.93; p = 0.012], respectively), driven mainly by target lesion revascularization (5.7% vs. 8.8%; p = 0.018). The rate of definite stent thrombosis was similar in both groups (2.2% vs. 2.5%; p = 0.590). No differences were found between the groups in terms of target lesion revascularization (1.4% vs. 1.3%; p = 0.963) and definite or probable stent thrombosis (0.6% vs. 0.4%; p = 0.703) between 5 and 10 years. CONCLUSIONS At 10-year follow-up, EES demonstrated confirmed superiority in combined patient- and device-oriented composite endpoints compared with bare-metal stents in patients with STEMI requiring primary percutaneous coronary intervention. Between 5- and 10-year follow-up, a low incidence of adverse cardiovascular events related to device failure was found in both groups. (10-Years Follow-Up of the EXAMINATION Trial; NCT04462315).
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Affiliation(s)
- Salvatore Brugaletta
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
| | - Josep Gomez-Lara
- Hospital Universitari de Bellvitge, Institut d´Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Luis Ortega-Paz
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | | | | | | | - Loreto Oyarzabal
- Hospital Universitari de Bellvitge, Institut d´Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | | | | | | | | | | | | | | | | | | | - Matteo Tebaldi
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | - Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | - Juan Jose Rodriguez-Arias
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | | | - Victor Arevalos
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Rafael Romaguera
- Hospital Universitari de Bellvitge, Institut d´Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Joan Antoni Gomez-Hospital
- Hospital Universitari de Bellvitge, Institut d´Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Patrick W Serruys
- International Center of Circulatory Health, Imperial College London, London, United Kingdom; Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Manel Sabaté
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain; CIBER-CV, Instituto de Salud Carlos III, Spain
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Zhang WJ, Qiao X, Guo WF, Liang XY, Li Y, Wang ZL. Duration of Dual Antiplatelet Therapy in Patients With Acute Coronary Syndrome Treated With New Generation Stents: A Meta-Analysis of Randomized Controlled Trials. Front Cardiovasc Med 2021; 8:615396. [PMID: 33614748 PMCID: PMC7886789 DOI: 10.3389/fcvm.2021.615396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objective: The optimum duration of dual antiplatelet therapy (DAPT) remains uncertain in patients with acute coronary syndrome treated with new generation stents. This meta-analysis was performed to investigate ischemia and bleeding outcomes with different DAPT strategies. Methods: PubMed, Embase, Cochrane and Web of science from inception to May 27, 2020, were systematically searched. Randomized controlled trials were included to compare short-term (6 months or less) with standard (12 months) DAPT in patients with acute coronary syndrome treated with new generation stents. The primary endpoints were myocardial infarction, definite or probable stent thrombosis and major bleeding. The secondary endpoints included all-cause death, cardiovascular death, stroke, target vessel revascularization and net adverse clinical events. Random effect model and fixed effect model were used to calculate the odds ratio (OR) and 95% confidence interval (CI) of each endpoint. Results: Four randomized controlled trials and seven subgroup analyses of larger randomized controlled trials, including a total of 21,344 patients with acute coronary syndrome, met our inclusion criteria. The shorter DAPT was associated with significantly lower major bleeding compared with the standard DAPT (OR 0.71, 95% CI 0.56–0.90, P = 0.005, I2 = 25%), while without increasing the risk of myocardial infarction (OR 1.18, 0.88–1.58, P = 0.28, I2 = 20%), definite or probable stent thrombosis (OR 1.60, 0.98–2.59, P = 0.06, I2 = 0%). No significantly difference was observed in the risk of all-cause death (OR 0.96, 0.72–1.27, P = 0.76, I2 = 2%), cardiovascular death (OR 0.91, 0.62–1.33, P = 0.62, I2 = 0%), stroke (OR 0.84, 0.54–1.30, P = 0.43, I2 = 0%), target vessel revascularization (OR 1.14, 0.84–1.55, P = 0.41, I2 = 8%), and net adverse clinical events (OR 0.93, 0.80–1.07, P = 0.3, I2 = 18%) between the two groups. Conclusions: In patients with acute coronary syndrome treated with new generation stents, the shorter DAPT leads to a marked reduction in the risk of major bleeding compared with the standard DAPT. This benefit is achieved without increasing the risk of mortality or ischemic outcomes. The study protocol was registered in PROSPERO (CRD42020189871).
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Affiliation(s)
- Wen-Jiao Zhang
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Xuan Qiao
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Wen-Fen Guo
- Department of Cardiology, Baiyin Third People's Hospital, Baiyin, China
| | - Xi-Ying Liang
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Yan Li
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Zhi-Lu Wang
- Department of Cardiology, The First Hospital of Lanzhou University, Lanzhou, China
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Papapostolou S, Dinh DT, Noaman S, Biswas S, Duffy SJ, Stub D, Shaw JA, Walton A, Sharma A, Brennan A, Clark D, Freeman M, Yip T, Ajani A, Reid CM, Oqueli E, Chan W. Effect of Age on Clinical Outcomes in Elderly Patients (>80 Years) Undergoing Percutaneous Coronary Intervention: Insights From a Multi-Centre Australian PCI Registry. Heart Lung Circ 2021; 30:1002-1013. [PMID: 33478864 DOI: 10.1016/j.hlc.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 11/20/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To evaluate the effect of age in an all-comers population undergoing percutaneous coronary intervention (PCI). BACKGROUND Age is an important consideration in determining appropriateness for invasive cardiac assessment and perceived clinical outcomes. METHODS We analysed data from 29,012 consecutive patients undergoing PCI in the Melbourne Interventional Group (MIG) registry between 2005 and 2017. 25,730 patients <80 year old (78% male, mean age 62±10 years; non-elderly cohort) were compared to 3,282 patients ≥80 year old (61% male, mean age 84±3 years; elderly cohort). RESULTS The elderly cohort had greater prevalence of hypertension, diabetes and previous myocardial infarction (all p<0.001). Elderly patients were more likely to present with acute coronary syndromes, left ventricular ejection fraction <45% and chronic kidney disease (p<0.0001). In-hospital, 30-day and long-term all-cause mortality (over a median of 3.6 and 5.1 years for elderly and non-elderly cohorts, respectively) were higher in the elderly cohort (5.2% vs. 1.9%; 6.4% vs. 2.2%; and 43% vs. 14% respectively, all p<0.0001). In multivariate Cox regression analysis, estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2 (HR 3.8, 95% CI: 3.4-4.3), cardiogenic shock (HR 3.0, 95% CI: 2.6-3.4), ejection fraction <30% (HR 2.5, 95% CI: 2.1-2.9); and age ≥80 years (HR 2.8, 95% CI: 2.6-3.1) were independent predictors of long-term all-cause mortality (all p<0.0001). CONCLUSION The elderly cohort is a high-risk group of patients with increasing age being associated with poorer long-term mortality. Age, thus, should be an important consideration when individualising treatment in elderly patients.
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Affiliation(s)
| | - Diem T Dinh
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | | | | | | | - Dion Stub
- Alfred Health, Melbourne, Vic, Australia
| | | | | | - Anand Sharma
- Ballarat Base Hospital, Ballarat Central, Vic, Australia
| | - Angela Brennan
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | | | | | | | - Andrew Ajani
- Royal Melbourne Hospital, Melbourne, Vic, Australia; The University of Melbourne, Melbourne, Vic, Australia
| | | | - Ernesto Oqueli
- Ballarat Base Hospital, Ballarat Central, Vic, Australia
| | - William Chan
- Alfred Health, Melbourne, Vic, Australia; The University of Melbourne, Melbourne, Vic, Australia.
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Woo HG, Lee HA, Ryu DR, Song TJ. Association of Mortality with Antiplatelet Treatment in Patients with Stent Placement or Angioplasty: A Population-Based Nested Case-Control Study. Yonsei Med J 2021; 62:75-85. [PMID: 33381937 PMCID: PMC7820450 DOI: 10.3349/ymj.2021.62.1.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/22/2020] [Accepted: 10/19/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Antiplatelet drugs are essential in patients with cardiovascular disease who undergo stent placement. We hypothesized that risks of mortality would differ according to adherence to antiplatelet agents, number of antiplatelet agents, and antiplatelet regimens in patients undergoing stent placement or angioplasty. MATERIALS AND METHODS Between 2002 and 2013, we initially enrolled 8671 subjects who underwent stent placement or angioplasty in the National Health Insurance Service-National Sample Cohort in Korea. Using the International Classification of Diseases, 10th revision, the incidence of all-cause death, including cardiovascular disease, cerebrovascular disease, and cancer, was defined. Using a nested case-control study design, controls were matched to cases at a ratio of 4:1, and a total of 5415 subjects were eligible for this study. RESULTS During a median follow-up period of 3.51 years, the incidence rate of all-cause death was 40 per 1000 person-years. We found that adherence to antiplatelet monotherapy significantly decreased risk of death by cerebro-cardiovascular disease, compared with discontinuation of antiplatelets [adjusted odds ratio (OR) 0.62, 95% confidence interval (CI) (0.41-0.96)]. Compared with dual antiplatelet therapy (DAPT), aspirin and clopidogrel monotherapy significantly reduced death by cerebro-cardiovascular disease [adjusted OR 0.65, 95% CI (0.44-0.95) and adjusted OR 0.58, 95% CI (0.35-0.96), respectively]. There was no significant difference of mortality between aspirin monotherapy and clopidogrel monotherapy. CONCLUSION Our study demonstrated that adherence to antiplatelet therapy and antiplatelet monotherapy, compared with DAPT, in patients with stent placement or angioplasty may have a beneficial effect on mortality in cerebro-cardiovascular disease.
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Affiliation(s)
- Ho Geol Woo
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Hye Ah Lee
- Clinical Trial Center, Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Dong Ryeol Ryu
- Department of Nephrology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Tae Jin Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea.
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48
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Gaudino M, Hameed I, Farkouh ME, Rahouma M, Naik A, Robinson NB, Ruan Y, Demetres M, Biondi-Zoccai G, Angiolillo DJ, Bagiella E, Charlson ME, Benedetto U, Ruel M, Taggart DP, Girardi LN, Bhatt DL, Fremes SE. Overall and Cause-Specific Mortality in Randomized Clinical Trials Comparing Percutaneous Interventions With Coronary Bypass Surgery: A Meta-analysis. JAMA Intern Med 2020; 180:1638-1646. [PMID: 33044497 PMCID: PMC7551235 DOI: 10.1001/jamainternmed.2020.4748] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
IMPORTANCE Mortality is a common outcome in trials comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG). Controversy exists regarding whether all-cause mortality or cardiac mortality is preferred as a study end point, because noncardiac mortality should be unrelated to the treatment. OBJECTIVE To evaluate the difference in all-cause and cause-specific mortality in randomized clinical trials (RCTs) comparing PCI with CABG for the treatment of patients with coronary artery disease. DATA SOURCES MEDLINE (1946 to the present), Embase (1974 to the present), and the Cochrane Library (1992 to the present) databases were searched on November 24, 2019. Reference lists of included articles were also searched, and additional studies were included if appropriate. STUDY SELECTION Articles were considered for inclusion if they were in English, were RCTs comparing PCI with drug-eluting or bare-metal stents and CABG for the treatment of coronary artery disease, and reported mortality and/or cause-specific mortality. Trials of PCI involving angioplasty without stenting were excluded. For each included trial, the publication with the longest follow-up duration for each outcome was selected. DATA EXTRACTION AND SYNTHESIS For data extraction, all studies were reviewed by 2 independent investigators, and disagreements were resolved by a third investigator in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline. Data were pooled using fixed- and random-effects models. MAIN OUTCOMES AND MEASURES The primary outcomes were all-cause and cause-specific (cardiac vs noncardiac) mortality. Subgroup analyses were performed for PCI trials using drug-eluting vs bare-metal stents and for trials involving patients with left main disease. RESULTS Twenty-three unique trials were included involving 13 620 unique patients (6829 undergoing PCI and 6791 undergoing CABG; men, 39.9%-99.0% of study populations; mean age range, 60.0-71.0 years). The weighted mean (SD) follow-up was 5.3 (3.6) years. Compared with CABG, PCI was associated with a higher rate of all-cause (incidence rate ratio, 1.17; 95% CI, 1.05-1.29) and cardiac (incidence rate ratio, 1.24; 95% CI, 1.05-1.45) mortality but also noncardiac mortality (incidence rate ratio, 1.19; 95% CI, 1.00-1.41). CONCLUSIONS AND RELEVANCE Percutaneous coronary intervention was associated with higher all-cause, cardiac, and noncardiac mortality compared with CABG at 5 years. The significantly higher noncardiac mortality associated with PCI suggests that even noncardiac deaths after PCI may be procedure related and supports the use of all-cause mortality as the end point for myocardial revascularization trials.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Irbaz Hameed
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.,Section of Cardiothoracic Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Michael E Farkouh
- Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada
| | - Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Ajita Naik
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - N Bryce Robinson
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Yongle Ruan
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Michelle Demetres
- Samuel J. Wood Library and C. V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, New York
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Mediterranea Cardiocentro, Napoli, Italy
| | - Dominick J Angiolillo
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville
| | - Emilia Bagiella
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mary E Charlson
- Division of General Internal Medicine, Weill Cornell Medical College, New York, New York
| | - Umberto Benedetto
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Marc Ruel
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - David P Taggart
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Stephen E Fremes
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Hara H, Serruys PW, Takahashi K, Kawashima H, Ono M, Gao C, Wang R, Mohr FW, Holmes DR, Davierwala PM, Head SJ, Thuijs DJ, Milojevic M, Kappetein AP, Garg S, Onuma Y, Mack MJ. Impact of Peri-Procedural Myocardial Infarction on Outcomes After Revascularization. J Am Coll Cardiol 2020; 76:1622-1639. [DOI: 10.1016/j.jacc.2020.08.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
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50
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Riehle L, Maier B, Behrens S, Bruch L, Schoeller R, Schühlen H, Stockburger M, Theres H, Leistner DM, Landmesser U, Fröhlich GM. Changes in treatment for NSTEMI in women and the elderly over the past 16 years in a large real-world population. Int J Cardiol 2020; 316:7-12. [DOI: 10.1016/j.ijcard.2020.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 01/11/2023]
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